Healthcare Provider Details

I. General information

NPI: 1558207019
Provider Name (Legal Business Name): TAYLOR DEMENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. TAYLOR LOUDERMILL

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3606 N MARTIN LUTHER KING JR BLVD
TULSA OK
74106-6459
US

IV. Provider business mailing address

3606 N MARTIN LUTHER KING JR BLVD
TULSA OK
74106-6459
US

V. Phone/Fax

Practice location:
  • Phone: 918-949-4212
  • Fax: 918-949-4299
Mailing address:
  • Phone: 918-949-4212
  • Fax: 918-949-4299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: