Healthcare Provider Details

I. General information

NPI: 1154713220
Provider Name (Legal Business Name): PAULA TAYLOR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2728 SUNSET BLVD
LEXINGTON SC
29072
US

IV. Provider business mailing address

623 QUEENLAND CT
LEXINGTON SC
29072-7980
US

V. Phone/Fax

Practice location:
  • Phone: 803-603-7229
  • Fax:
Mailing address:
  • Phone: 803-603-7229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19345
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number56910
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: