MEDICARE: MR. MBE SYLVESTER TAYOURH PMHNP

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	364SP0813X	Geropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist	1114373	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1114373	TX
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0106502	CO
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	75598	NM
5	163W00000X	Registered Nurse	867533	TX

General Provider Information

NPI Number	:	1801253083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MBE SYLVESTER TAYOURH PMHNP

Provider Business Mailing Address
First Line	:	3112 ANDERSON RD NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-1483
Country	:	US
Telephone Number	:	202-706-0905
Fax Number	:	505-581-8035

Provider Business Practice Location Address
First Line	:	3112 ANDERSON RD NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-1483
Country	:	US
Telephone Number	:	202-706-0905
Fax Number	:	505-581-8035

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

Provider Enumeration Date	:	01/19/2016
Last Update Date	:	04/22/2026

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