Provider Demographics
NPI:1033359369
Name:TAYLOR, JARED ROSS (PA-C)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:ROSS
Last Name:TAYLOR
Suffix:
Gender:M
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 1:4755 W ANN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-3424
Mailing Address - Country:US
Mailing Address - Phone:702-645-0332
Mailing Address - Fax:
Practice Address - Street 1:1100 WILFORD HALL LOOP
Practice Address - Street 2:
Practice Address - City:JBSA LACKLAND
Practice Address - State:TX
Practice Address - Zip Code:78236
Practice Address - Country:US
Practice Address - Phone:210-292-4774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVFNP-363LF0000X363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4378OtherARIZONA REGULATORY BOARD OF PHYSICIAN ASSISTANTS
NVCS22548OtherNEVADA STATE BOARD OF PHARMACY
AZ414670Medicaid
NVPA1142OtherNEVADA BOARD OF MEDICAL EXAMINERS
AZ4378OtherARIZONA REGULATORY BOARD OF PHYSICIAN ASSISTANTS