Provider Demographics
NPI:1114675030
Name:THOMAS, TAYLOR LOUISE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LOUISE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 PIGEONBROOK CT
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-8916
Mailing Address - Country:US
Mailing Address - Phone:309-262-0899
Mailing Address - Fax:
Practice Address - Street 1:3533 PIGEONBROOK CT
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8916
Practice Address - Country:US
Practice Address - Phone:309-262-0899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant