Healthcare Provider Details

I. General information

NPI: 1063304798
Provider Name (Legal Business Name): TAYLOR GILBERT JESSEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 N STATE OF FRANKLIN RD
JOHNSON CITY TN
37604-6034
US

IV. Provider business mailing address

135 OLD GRAY STATION RD APT 617
JOHNSON CITY TN
37615-3545
US

V. Phone/Fax

Practice location:
  • Phone: 423-975-0068
  • Fax:
Mailing address:
  • Phone: 276-780-7867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48862
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: