=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659414522
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH S. TAYLOR MD, MASTERSPUBHLTH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2007
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 422 COLONIAL DR COMMUNITY EMPOWERMENT SERVICES
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70806-6505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-292-5151
-----------------------------------------------------
Fax | 225-292-5152
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6765 CORPORATE BLVD., #5306
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | MD15104R
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------