Individual
CHRISTINE ANNETTE TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCP
Contact information
Practice address
112 RAINBOW DR, CABOT, AR 72023-8657
(501) 804-3057
Mailing address
112 RAINBOW DR, CABOT, AR 72023-8657
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0832190
TATTOO ARTIST CERTIFICATE
AR
Enumeration date
12/16/2019
Last updated
12/16/2019
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