Healthcare Provider Details

I. General information

NPI: 1356326896
Provider Name (Legal Business Name): GLORIA JEAN TAYLOR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 CUMBERLAND FALLS HWY
CORBIN KY
40701-2722
US

IV. Provider business mailing address

1419 CUMBERLAND FALLS HWY
CORBIN KY
40701-2722
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-4481
  • Fax: 606-528-2857
Mailing address:
  • Phone: 606-528-4481
  • Fax: 606-528-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3003783
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: