Healthcare Provider Details

I. General information

NPI: 1215567854
Provider Name (Legal Business Name): ALYSSA CAROLYN TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 MEMORIAL DR
CULLOWHEE NC
28723-8911
US

IV. Provider business mailing address

1121 BARBARA ANN CIR APT 5
WINSTON SALEM NC
27103-6173
US

V. Phone/Fax

Practice location:
  • Phone: 336-430-8263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: