Provider Demographics
NPI:1174890065
Name:MARSHALL, TAYLOR DEE (APN)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:DEE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:DEE
Other - Last Name:SHACKELFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3211 N NORTHHILLS BLVD
Mailing Address - Street 2:#110
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4007
Mailing Address - Country:US
Mailing Address - Phone:479-381-3358
Mailing Address - Fax:
Practice Address - Street 1:3211 N NORTHHILLS BLVD
Practice Address - Street 2:#110
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4007
Practice Address - Country:US
Practice Address - Phone:479-381-3358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR8720363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner