Healthcare Provider Details

I. General information

NPI: 1053915850
Provider Name (Legal Business Name): TAYLOR RAE HOOKER MS, CTRS, NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MINE LAKE CT
RALEIGH NC
27615-6417
US

IV. Provider business mailing address

1144 PARSONAGE ST
ELIZABETH CITY NC
27909-3304
US

V. Phone/Fax

Practice location:
  • Phone: 800-516-0975
  • Fax:
Mailing address:
  • Phone: 757-286-2029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3084110
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number66891
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: