Healthcare Provider Details

I. General information

NPI: 1174433080
Provider Name (Legal Business Name): TAYLOR KNOTTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 ASBURY AVE
CUMBERLAND MD
21502-7512
US

IV. Provider business mailing address

57 PARKER RD
RIDGELEY WV
26753-5302
US

V. Phone/Fax

Practice location:
  • Phone: 240-362-7263
  • Fax:
Mailing address:
  • Phone: 304-209-9152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number119704
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: