Healthcare Provider Details

I. General information

NPI: 1790698256
Provider Name (Legal Business Name): TAURUS LAURIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 CATHERINE ST
BRISTOL VA
24201-3270
US

IV. Provider business mailing address

2448 CATHERINE ST
BRISTOL VA
24201-3270
US

V. Phone/Fax

Practice location:
  • Phone: 276-696-5219
  • Fax:
Mailing address:
  • Phone: 276-696-5219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: