MEDICARE: TAYLOR R. MATHERNE APRN-FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	221506	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	221506	OTHER	LA	NP LICENSE NUMBER

General Provider Information

NPI Number	:	1073282075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR R. MATHERNE APRN-FNP-C

Provider Business Mailing Address
First Line	:	10101 PARK ROWE AVE STE 200
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-1685
Country	:	US
Telephone Number	:	225-769-2200
Fax Number	:	225-768-2185

Provider Business Practice Location Address
First Line	:	19065 DR JOHN LAMBERT DR STE 2000B
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-1027
Country	:	US
Telephone Number	:	985-293-2030
Fax Number	:	833-756-2682

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2021
Last Update Date	:	11/11/2024

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