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General NPI Number Information
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NPI Number | 1740432053
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Entity Type | Organization
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Legal Business Name | TAYLOR REGIONAL MEDICAL GROUP,LLC
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Dates
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Enumeration Date | 10/17/2008
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 1698 OLD LEBANON RD SUITE 3B
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City | CAMPBELLSVILLE
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State | KY
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Zip | 42718
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Country | US
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Telephone | 270-789-2445
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Fax |
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Provider Business Mailing Address
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Address Line | 1698 OLD LEBANON RD
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City | CAMPBELLSVILLE
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State | KY
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Zip | 42718-9662
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Country | US
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Telephone | 270-789-6087
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Fax | 270-789-6119
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Authorized Official
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Title or Position | COORDINATOR
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Name | DEBRA WALDRON
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Credential |
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Telephone | 270-465-3561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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