Healthcare Provider Details

I. General information

NPI: 1851069538
Provider Name (Legal Business Name): JESSICA LYN TAYLOR ARNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 10/27/2024
Certification Date: 10/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIAGN ARMY MEDICAL CENTER 9040 JACKSON AVENUE
TACOMA WA
98431-1200
US

IV. Provider business mailing address

690 BARNES BLVD
JOINT BASE LEWIS MCCHORD WA
98438-1303
US

V. Phone/Fax

Practice location:
  • Phone: 865-567-3530
  • Fax:
Mailing address:
  • Phone: 253-982-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61226463
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number61042185
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: