Healthcare Provider Details

I. General information

NPI: 1841118759
Provider Name (Legal Business Name): TAYLOR LUSK BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 MCDOWELL ST
WELCH WV
24801-2029
US

IV. Provider business mailing address

454 MCDOWELL ST
WELCH WV
24801-2029
US

V. Phone/Fax

Practice location:
  • Phone: 304-436-8630
  • Fax:
Mailing address:
  • Phone: 304-436-8630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number83977
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: