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General NPI Number Information
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NPI Number | 1255924809
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Entity Type | Individual
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Provider Name | LARA TAYLOR APRN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/15/2021
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Last Update Date | 04/02/2021
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Provider Practice Location Address
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Address Line | 1405 N TRUMAN BLVD
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City | FESTUS
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State | MO
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Zip | 63028-1177
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Country | US
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Telephone | 636-933-2243
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Fax |
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Provider Business Mailing Address
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Address Line | 10010 KENNERLY RD
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2106
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Country | US
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Telephone | 636-236-1067
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Fax |
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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 | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 2021004251
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2021004251
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License Number State | MO
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