Healthcare Provider Details

I. General information

NPI: 1588403281
Provider Name (Legal Business Name): MADISON MCKENZIE TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 CENTRAL PIKE STE 351
HERMITAGE TN
37076-3422
US

IV. Provider business mailing address

3024 BUSINESS PARK CIR
GOODLETTSVILLE TN
37072-3132
US

V. Phone/Fax

Practice location:
  • Phone: 615-889-8802
  • Fax: 615-889-0583
Mailing address:
  • Phone: 615-239-2018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number35609
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: