Provider Demographics
NPI:1033355367
Name:TAYLOR, LINDSAY SUE (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:SUE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 E H ST
Mailing Address - Street 2:
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-3589
Mailing Address - Country:US
Mailing Address - Phone:308-344-4110
Mailing Address - Fax:308-344-8369
Practice Address - Street 1:1401 E H ST
Practice Address - Street 2:
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-3589
Practice Address - Country:US
Practice Address - Phone:308-344-4110
Practice Address - Fax:308-344-8369
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1473363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47074801112Medicaid