MEDICARE: TAYLOR ELIZABETH WATSON

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	171M00000X	Case Manager/Care Coordinator
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1083380505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR ELIZABETH WATSON

Provider Business Mailing Address
First Line	:	79 SAND PEBBLE DR STE A
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-7591
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	79 SAND PEBBLE DR STE A
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-7591
Country	:	US
Telephone Number	:	901-443-9146
Fax Number	:

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

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	04/01/2025

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