Healthcare Provider Details

I. General information

NPI: 1962226092
Provider Name (Legal Business Name): TAELOR MCKENZIE DEIKE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2837 BROADSTONE ROAD
BANNER ELK NC
28604
US

IV. Provider business mailing address

150 WYNDHAM WAY
BOONE NC
28607-6786
US

V. Phone/Fax

Practice location:
  • Phone: 828-260-9255
  • Fax:
Mailing address:
  • Phone: 512-730-9455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1178699
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: