Healthcare Provider Details

I. General information

NPI: 1235047085
Provider Name (Legal Business Name): JESSICA MARIE TAYLOR LMBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8358 SIX FORKS RD STE 204
RALEIGH NC
27615-5093
US

IV. Provider business mailing address

6549 NEW MARKET WAY
RALEIGH NC
27615-6829
US

V. Phone/Fax

Practice location:
  • Phone: 919-413-2294
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number16577
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: