1851899322 NPI number — MS. TAYLOR COUNTISS COFFEY PA-C

Table of content: MS. TAYLOR COUNTISS COFFEY PA-C (NPI 1851899322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851899322 NPI number — MS. TAYLOR COUNTISS COFFEY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COFFEY
Provider First Name:
TAYLOR
Provider Middle Name:
COUNTISS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COUNTISS
Provider Other First Name:
TAYLOR
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851899322
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
WALKER BAPTIST MEDICAL CENTER
Provider Second Line Business Mailing Address:
3500 HIGHWAY 78 E.
Provider Business Mailing Address City Name:
JASPER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-387-4188
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 HIGHWAY 78 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35501-8956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-387-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2018

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: 363AM0700X , with the licence number:  1150472 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AS0400X , with the licence number: 1150472 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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