MEDICARE: CHELSEA TAYLOR

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	164W00000X	Licensed Practical Nurse	85497	TN

General Provider Information

NPI Number	:	1346097557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA TAYLOR

Provider Business Mailing Address
First Line	:	2811 LAKE CITY HWY
Second Line	:
City	:	ROCKY TOP
State	:	TN
Zip	:	37769-5530
Country	:	US
Telephone Number	:	865-850-6863
Fax Number	:

Provider Business Practice Location Address
First Line	:	2811 LAKE CITY HWY
Second Line	:
City	:	ROCKY TOP
State	:	TN
Zip	:	37769-5530
Country	:	US
Telephone Number	:	865-850-6863
Fax Number	:

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

Provider Enumeration Date	:	05/04/2024
Last Update Date	:	05/04/2024

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