Individual
MR. STACY LEE TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
3100 OAK GROVE RD, POPLAR BLUFF, MO 63901-1573
(573) 776-2000
Mailing address
2502 FOX DR, POPLAR BLUFF, MO 63901-2102
(573) 300-8115
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2011021213
MO
163WG0000X
General Practice Registered Nurse
2011021213
MO
163WM0705X
Medical-Surgical Registered Nurse
2011021213
MO
Other
Enumeration date
07/17/2017
Last updated
07/17/2017
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