MEDICARE: TAYLOR NICOLE PRATT HIS

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	237700000X	Hearing Instrument Specialist	671	AR

General Provider Information

NPI Number	:	1689309809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR NICOLE PRATT HIS

Provider Business Mailing Address
First Line	:	106 S INGLEWOOD AVE STE A
Second Line	:
City	:	RUSSELLVILLE
State	:	AR
Zip	:	72801-3353
Country	:	US
Telephone Number	:	479-449-6716
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 S INGLEWOOD AVE STE A
Second Line	:
City	:	RUSSELLVILLE
State	:	AR
Zip	:	72801-3353
Country	:	US
Telephone Number	:	479-449-6716
Fax Number	:

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

Provider Enumeration Date	:	07/21/2022
Last Update Date	:	07/21/2022

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