Healthcare Provider Details

I. General information

NPI: 1922368158
Provider Name (Legal Business Name): LINDA D. TAYLOR IECE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MAYS CHAPEL RD
LEBANON KY
40033-8675
US

IV. Provider business mailing address

205 MAYS CHAPEL RD
LEBANON KY
40033-8675
US

V. Phone/Fax

Practice location:
  • Phone: 270-465-1623
  • Fax:
Mailing address:
  • Phone: 270-465-1623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: