Healthcare Provider Details

I. General information

NPI: 1437921657
Provider Name (Legal Business Name): TAYLOR NICOLE SALYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17285 VETERANS MEMORIAL HWY
DUNGANNON VA
24245-3937
US

IV. Provider business mailing address

18495 SANDY RIDGE RD
SAINT PAUL VA
24283-2691
US

V. Phone/Fax

Practice location:
  • Phone: 276-467-2201
  • Fax:
Mailing address:
  • Phone: 276-870-2257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024188543
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: