Provider Demographics
NPI:1871062349
Name:TAYLOR, NICHOLE MARIE (APRN, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
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 3525
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-3525
Mailing Address - Country:US
Mailing Address - Phone:307-363-0883
Mailing Address - Fax:949-404-6138
Practice Address - Street 1:801 E 4TH ST STE 14A
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4061
Practice Address - Country:US
Practice Address - Phone:307-710-8527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYMT5055050363L00000X
WY41951.1832363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health