Healthcare Provider Details

I. General information

NPI: 1649759069
Provider Name (Legal Business Name): JAMES C TAYLOR APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5848 S FASHION BLVD # 300E
MURRAY UT
84107-6170
US

IV. Provider business mailing address

3396 S MEADOW CLOVER CT
WEST VALLEY CITY UT
84128-7808
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-4100
  • Fax:
Mailing address:
  • Phone: 801-520-1363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number308782-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: