Healthcare Provider Details

I. General information

NPI: 1972822732
Provider Name (Legal Business Name): CARMEN G TAYLOR A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EVERETT DR 7TH FLOOR, NICU
OKLAHOMA CITY OK
73104-5047
US

IV. Provider business mailing address

2117 BONNYCASTLE LN
YUKON OK
73099-7957
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5215
  • Fax:
Mailing address:
  • Phone: 405-324-8324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number75601
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: