Healthcare Provider Details

I. General information

NPI: 1548171390
Provider Name (Legal Business Name): MATTHEW TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8116 SISTERS LN
DENVER NC
28037-8821
US

IV. Provider business mailing address

8116 SISTERS LN
DENVER NC
28037-8821
US

V. Phone/Fax

Practice location:
  • Phone: 704-560-1178
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number337994
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: