Healthcare Provider Details

I. General information

NPI: 1902531577
Provider Name (Legal Business Name): TAYLOR WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8261 MARKET ST
BOARDMAN OH
44512-6254
US

IV. Provider business mailing address

8261 MARKET ST
BOARDMAN OH
44512-6254
US

V. Phone/Fax

Practice location:
  • Phone: 330-286-0050
  • Fax:
Mailing address:
  • Phone: 330-286-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0031686
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: