Healthcare Provider Details

I. General information

NPI: 1558279711
Provider Name (Legal Business Name): TAYLOR BOOTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 FALSTAFF RD
RALEIGH NC
27610-1812
US

IV. Provider business mailing address

7193 HUNTER RIDGE RD
ROCKY MOUNT NC
27803-9025
US

V. Phone/Fax

Practice location:
  • Phone: 800-447-1800
  • Fax:
Mailing address:
  • Phone: 252-469-9007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5025358
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: