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General NPI Number Information
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NPI Number | 1013667831
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Entity Type | Individual
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Provider Name | LASHAWNDA KATINA TAYLOR FNP
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Gender | Female
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Dates
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Enumeration Date | 03/25/2022
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 100 MYRTLE BOULEVARD
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City | GRACEWOOD
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State | GA
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Zip | 30812
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Country | US
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Telephone | 706-790-2011
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2510
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City | AUGUSTA
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State | GA
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Zip | 30809-2510
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Country | US
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Telephone | 706-922-8251
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Fax | 706-922-6695
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN152884
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License Number State | GA
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