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General NPI Number Information
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NPI Number | 1770620684
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Entity Type | Individual
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Provider Name | TIMOTHY N TAYLOR PMHNP
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Gender | Male
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 182 SW ACADEMY ST STE 304
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City | DALLAS
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State | OR
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Zip | 97338-1900
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Country | US
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Telephone | 503-813-7771
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Fax |
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Provider Business Mailing Address
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Address Line | 37941 ALEXANDER RD
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City | PHILOMATH
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State | OR
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Zip | 97370-9736
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Country | US
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Telephone | 541-745-8098
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2000150157NP
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License Number State | OR
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