1750327508 NPI number — DEBRA N TAYLOR CRNA

Table of content: DEBRA N TAYLOR CRNA (NPI 1750327508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750327508 NPI number — DEBRA N TAYLOR CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
DEBRA
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750327508
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE VIRGINIA AVENUE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-490-0916
Provider Business Mailing Address Fax Number:
401-490-0979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 STANAFORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BECKLEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25801-3142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-255-3000
Provider Business Practice Location Address Fax Number:
304-255-3544
Provider Enumeration Date:
06/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  584742 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 87006 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 86389U . This is a "BC/BS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 134849100 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 202006360 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 134849101 . This is a "FIRSTCARE COMMERCIAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 200082600A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180908901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 202006360 . This is a "PRESBYTERIAN COMMERCIAL" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".