Healthcare Provider Details

I. General information

NPI: 1992651004
Provider Name (Legal Business Name): TAYLOR REGIONAL MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 KINGSWOOD DR
CAMPBELLSVILLE KY
42718-9634
US

IV. Provider business mailing address

1698 OLD LEBANON RD
CAMPBELLSVILLE KY
42718-3319
US

V. Phone/Fax

Practice location:
  • Phone: 270-789-1112
  • Fax: 270-789-6176
Mailing address:
  • Phone: 270-789-6087
  • Fax: 270-789-6119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHELLA A WYMER
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 270-465-3561