Healthcare Provider Details

I. General information

NPI: 1700792603
Provider Name (Legal Business Name): ZACHARY TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N MAIN ST
MUSKOGEE OK
74401-4078
US

IV. Provider business mailing address

111 LEANING TREE RD
FORT GIBSON OK
74434-7611
US

V. Phone/Fax

Practice location:
  • Phone: 918-300-1320
  • Fax:
Mailing address:
  • Phone: 918-300-1320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: