Healthcare Provider Details

I. General information

NPI: 1336841527
Provider Name (Legal Business Name): TAYLOR POTTS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR CORK

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E HOLLY BLVD
BRANDON SD
57005-1426
US

IV. Provider business mailing address

1101 E HOLLY BLVD
BRANDON SD
57005-1426
US

V. Phone/Fax

Practice location:
  • Phone: 605-582-3853
  • Fax:
Mailing address:
  • Phone: 605-582-3853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18696
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6336
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: