Healthcare Provider Details

I. General information

NPI: 1528651346
Provider Name (Legal Business Name): DEBRA CHARLENE TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4663 CANVAS NETTIE RD
CANVAS WV
26662-4114
US

IV. Provider business mailing address

PO BOX 162
CANVAS WV
26662-0162
US

V. Phone/Fax

Practice location:
  • Phone: 304-872-0106
  • Fax:
Mailing address:
  • Phone: 304-651-6685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: