Healthcare Provider Details

I. General information

NPI: 1245827104
Provider Name (Legal Business Name): COURTNEY TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13324 QUARTERHORSE RUN
ROUGEMONT NC
27572-9339
US

IV. Provider business mailing address

13324 QUARTERHORSE RUN
ROUGEMONT NC
27572-9339
US

V. Phone/Fax

Practice location:
  • Phone: 919-450-5549
  • Fax:
Mailing address:
  • Phone: 919-450-5549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number221765
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: