Provider Demographics
NPI:1700620184
Name:MODGLIN, TAYLOR N (APRN)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:N
Last Name:MODGLIN
Suffix:
Gender:F
Credentials:APRN
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 497
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-0497
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:870-301-2092
Practice Address - Street 1:120 N 4TH ST
Practice Address - Street 2:
Practice Address - City:BARLOW
Practice Address - State:KY
Practice Address - Zip Code:42024-9579
Practice Address - Country:US
Practice Address - Phone:270-334-3131
Practice Address - Fax:270-334-3173
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4044830363L00000X, 363LF0000X
FL11041349363L00000X
IL209029871363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty