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Individual
JIMMY TAYLOR
Active
Individual
JIMMY TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN, QBHP
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L25394
AR
171M00000X
Case Manager/Care Coordinator
—
AR
Other
Enumeration date
07/17/2018
Last updated
07/17/2018
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