Provider Demographics
NPI:1316537178
Name:KING, TAYLOR JO (PA-C)
Entity Type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:JO
Last Name:KING
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 1:1956 130TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:IA
Mailing Address - Zip Code:51030-8022
Mailing Address - Country:US
Mailing Address - Phone:712-202-8396
Mailing Address - Fax:
Practice Address - Street 1:2730 PIERCE ST STE 300
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3765
Practice Address - Country:US
Practice Address - Phone:712-234-8725
Practice Address - Fax:712-234-8728
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA107223363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty