Provider Demographics
NPI:1528305224
Name:TAYLOR, STEPHANIE JUDITH (FNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JUDITH
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1685
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75456-1685
Mailing Address - Country:US
Mailing Address - Phone:903-575-9408
Mailing Address - Fax:903-575-9611
Practice Address - Street 1:2015 MULBERRY AVE STE 210
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2319
Practice Address - Country:US
Practice Address - Phone:903-575-9408
Practice Address - Fax:903-575-9611
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122968363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX337063701Medicaid