Healthcare Provider Details

I. General information

NPI: 1972150837
Provider Name (Legal Business Name): DEAVAN TAYLOR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2019
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W MAIN ST
LEXINGTON KY
40507-1354
US

IV. Provider business mailing address

206 W MAIN ST
LEXINGTON KY
40507-1354
US

V. Phone/Fax

Practice location:
  • Phone: 859-710-6829
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4035710
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11003474
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11003474
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: