Provider Demographics
NPI:1700620408
Name:MAXIE, TAYLOR JAMIA (WHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:JAMIA
Last Name:MAXIE
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:JAMIA
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2120 BERT KOUNS INDUSTRIAL LOOP STE H
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3354
Mailing Address - Country:US
Mailing Address - Phone:318-688-3350
Mailing Address - Fax:318-300-4439
Practice Address - Street 1:2120 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3106
Practice Address - Country:US
Practice Address - Phone:318-688-3350
Practice Address - Fax:318-300-4439
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA235851363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health