Healthcare Provider Details

I. General information

NPI: 1679843551
Provider Name (Legal Business Name): PHILICIA ANN TAYLOR CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PHILICIA JACOBS KELLEY CRNA

II. Dates (important events)

Enumeration Date: 01/09/2012
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1272 GARRISON DR
MURFREESBORO TN
37129-2570
US

IV. Provider business mailing address

545 LAKE HILL RD
MANCHESTER TN
37355-4230
US

V. Phone/Fax

Practice location:
  • Phone: 615-867-8160
  • Fax: 615-867-7876
Mailing address:
  • Phone: 615-653-3255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number18285
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: