Provider Demographics
NPI:1033887823
Name:EVANS, TAYLOR DAWN (PA)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:DAWN
Last Name:EVANS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:TAYLOR
Other - Middle Name:DAWN
Other - Last Name:LAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1781 TATE BLVD SE STE 201
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4252
Mailing Address - Country:US
Mailing Address - Phone:828-328-2901
Mailing Address - Fax:828-327-6223
Practice Address - Street 1:1781 TATE BLVD SE STE 201
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4252
Practice Address - Country:US
Practice Address - Phone:828-328-2901
Practice Address - Fax:828-327-6223
Is Sole Proprietor?:No
Enumeration Date:2021-09-06
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11407207V00000X
NC0010114072084A0401X, 208VP0000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine