Healthcare Provider Details

I. General information

NPI: 1588155105
Provider Name (Legal Business Name): MRS. CARLIE WILLIAMS TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 EVANGELINE ST
MONROE LA
71201-3724
US

IV. Provider business mailing address

2910 EVANGELINE ST
MONROE LA
71201-3724
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-5553
  • Fax: 318-388-2910
Mailing address:
  • Phone: 318-388-5553
  • Fax: 318-388-2910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: