Provider Demographics
NPI:1346263886
Name:TAYLOR, KAREN E (PA-C)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:E
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 1:9222 W MILKWEED LOOP
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4361
Mailing Address - Country:US
Mailing Address - Phone:623-572-7711
Mailing Address - Fax:
Practice Address - Street 1:9222 W MILKWEED LOOP
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4361
Practice Address - Country:US
Practice Address - Phone:623-572-7711
Practice Address - Fax:623-572-7711
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2009-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2466207T00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ188316200OtherDEPT. OF LABOR
AZAZ020590OtherBC BS
AZ742090Medicaid
AZ1Z2577OtherHEALTHNET
AZ1Z2577OtherHEALTHNET
118900Medicare UPIN