Healthcare Provider Details

I. General information

NPI: 1407158884
Provider Name (Legal Business Name): BARBARA LEE TAYLOR DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 BERTHA WILSON RD
BLANCH NC
27212-9795
US

IV. Provider business mailing address

1188 BERTHA WILSON RD
BLANCH NC
27212-9795
US

V. Phone/Fax

Practice location:
  • Phone: 336-694-3286
  • Fax:
Mailing address:
  • Phone: 336-694-3286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number381
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number017059
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number017059
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number017059
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number017059
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: