Provider Demographics
NPI:1861087090
Name:BOHANNON, TAYLOR (CRNP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:BOHANNON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 WHETSTONE ST
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36460-2625
Mailing Address - Country:US
Mailing Address - Phone:251-743-5863
Mailing Address - Fax:
Practice Address - Street 1:159 WHETSTONE ST
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36460-2625
Practice Address - Country:US
Practice Address - Phone:251-743-5863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-125372363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily