Healthcare Provider Details

I. General information

NPI: 1265966634
Provider Name (Legal Business Name): TAYLER M JOHNSTON DNP, CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 PHYSICIANS DR
JACKSON TN
38305
US

IV. Provider business mailing address

72 PHYSICIANS DR
JACKSON TN
38305-2070
US

V. Phone/Fax

Practice location:
  • Phone: 731-668-4455
  • Fax:
Mailing address:
  • Phone: 731-668-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number22511
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number22511
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: