Provider Demographics
NPI:1689341414
Name:BUCHANAN TAYLOR, JACQUELINE JACQUES (DR)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:JACQUES
Last Name:BUCHANAN TAYLOR
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 VICTORIA AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-3616
Mailing Address - Country:US
Mailing Address - Phone:901-633-8607
Mailing Address - Fax:
Practice Address - Street 1:6910 VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-3616
Practice Address - Country:US
Practice Address - Phone:901-633-8607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-28
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0149325614101YP1600X
CA102X00000X
TX2811-1136-1171146D00000X, 146L00000X, 146N00000X, 163WC1600X
TXAR07030037V03163WC1400X, 163WH0200X, 163WM1400X, 1835P0018X, 2083P0500X, 374K00000X
TXAR07070037V03163WH1000X
TXAR07090065V041710I1002X, 405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No163WC1400XNursing Service ProvidersRegistered NurseCollege Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty
No405300000XOther Service ProvidersPrevention Professional