MEDICARE: JACQUELINE JACQUES BUCHANAN TAYLOR DR

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	101YP1600X	Pastoral Counselor	0149325614	CA
2	102X00000X	Poetry Therapist		CA
3	146D00000X	Personal Emergency Response Attendant	2811-1136-1171	TX
4	146L00000X	Paramedic	2811-1136-1171	TX
5	146N00000X	Basic Emergency Medical Technician	2811-1136-1171	TX
6	163WC1400X	College Health Registered Nurse	AR07030037V03	TX
7	163WC1600X	Continuing Education/Staff Development Registered Nurse	2811-1136-1171	TX
8	163WH0200X	Home Health Registered Nurse	AR07030037V03	TX
9	163WH1000X	Hospice Registered Nurse	AR07070037V03	TX
10	163WM1400X	Nurse Massage Therapist (NMT)	AR07030037V03	TX
11	1710I1002X	Independent Duty Corpsman	AR07090065V04	TX
12	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	AR07030037V03	TX
13	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	AR07030037V03	TX
14	405300000X	Prevention Professional	AR07090065V04	TX
15	374K00000X	Religious Nonmedical Practitioner	AR07030037V03	TX

General Provider Information

NPI Number	:	1689341414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE JACQUES BUCHANAN TAYLOR DR

Provider Business Mailing Address
First Line	:	6910 VICTORIA AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75209-3616
Country	:	US
Telephone Number	:	901-633-8607
Fax Number	:

Provider Business Practice Location Address
First Line	:	6910 VICTORIA AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75209-3616
Country	:	US
Telephone Number	:	901-633-8607
Fax Number	:

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

Provider Enumeration Date	:	08/28/2021
Last Update Date	:	08/28/2021

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