Healthcare Provider Details

I. General information

NPI: 1164192597
Provider Name (Legal Business Name): TAYLER GABRIELLE MEBANE MS, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BLAKE BLVD
PINEHURST NC
28374-8474
US

IV. Provider business mailing address

300 BLAKE BLVD
PINEHURST NC
28374-8474
US

V. Phone/Fax

Practice location:
  • Phone: 704-502-1802
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5015104
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: