MEDICARE: TAYLOR NICOLE WAXLEY 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	363L00000X	Nurse Practitioner	120206	AR

General Provider Information

NPI Number	:	1891646246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR NICOLE WAXLEY APRN

Provider Business Mailing Address
First Line	:	525 W FAULKNER ST
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 W FAULKNER ST
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4518
Country	:	US
Telephone Number	:	318-322-9252
Fax Number	:

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

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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Directions to “ TAYLOR NICOLE WAXLEY APRN” Practice Location

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