MEDICARE: TAYLOR GRAVES APRN

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	29376	SC

General Provider Information

NPI Number	:	1578380515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR GRAVES APRN

Provider Business Mailing Address
First Line	:	3793 MCDOWELL LN STE 200
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-7892
Country	:	US
Telephone Number	:	843-390-0877
Fax Number	:

Provider Business Practice Location Address
First Line	:	3793 MCDOWELL LN STE 200
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-7892
Country	:	US
Telephone Number	:	843-390-0877
Fax Number	:

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

Provider Enumeration Date	:	09/23/2024
Last Update Date	:	09/23/2024

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Directions to “ TAYLOR GRAVES APRN” Practice Location

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