Healthcare Provider Details

I. General information

NPI: 1124720503
Provider Name (Legal Business Name): JADE SELINA TAYLOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JADE SELINA TAYLOR MD

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4265 LAC SAINT PIERRE DR APT A
HARVEY LA
70058-6548
US

IV. Provider business mailing address

4265 LAC SAINT PIERRE DR APT A APT A
HARVEY LA
70058-6548
US

V. Phone/Fax

Practice location:
  • Phone: 504-479-1255
  • Fax:
Mailing address:
  • Phone: 504-479-1255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number1124720503
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code246YR1600X
TaxonomyRegistered Record Administrator
License Number1124720503
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: