Healthcare Provider Details

I. General information

NPI: 1619981339
Provider Name (Legal Business Name): TAYLOR REGIONAL MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL PARK DR STE B
CAMPBELLSVILLE KY
42718
US

IV. Provider business mailing address

1698 OLD LEBANON RD
CAMPBELLSVILLE KY
42718-3319
US

V. Phone/Fax

Practice location:
  • Phone: 270-465-0632
  • Fax: 270-465-0539
Mailing address:
  • Phone: 270-789-6087
  • Fax: 270-789-6119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBRA A WALDRON
Title or Position: OFFICE COORDINATOR
Credential:
Phone: 270-465-3561