Provider Demographics
NPI:1255068847
Name:PHILMORE, TAYLOR N
Entity type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:N
Last Name:PHILMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5586 QUEENS RING CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-4304
Mailing Address - Country:US
Mailing Address - Phone:901-491-4519
Mailing Address - Fax:
Practice Address - Street 1:5586 QUEENS RING CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-4304
Practice Address - Country:US
Practice Address - Phone:901-491-4519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN220004973343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)