Healthcare Provider Details

I. General information

NPI: 1073817581
Provider Name (Legal Business Name): TAYLOR REGIONAL MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 GREENBRIAR DR SUITE A
CAMPBELLSVILLE KY
42718-9617
US

IV. Provider business mailing address

1698 OLD LEBANON RD
CAMPBELLSVILLE KY
42718-3319
US

V. Phone/Fax

Practice location:
  • Phone: 270-465-3595
  • Fax: 270-789-2044
Mailing address:
  • Phone: 270-789-6087
  • Fax: 270-789-6119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEBRA ANN WALDRON
Title or Position: COORDINATOR
Credential:
Phone: 270-465-3561