Provider Demographics
NPI:1376256586
Name:BRASWELL, TAYLOR ANDREW (PA-C)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ANDREW
Last Name:BRASWELL
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 1:7314 SADIE RD
Mailing Address - Street 2:
Mailing Address - City:KENLY
Mailing Address - State:NC
Mailing Address - Zip Code:27542-9487
Mailing Address - Country:US
Mailing Address - Phone:252-373-1048
Mailing Address - Fax:
Practice Address - Street 1:1473 NC 42 43 W
Practice Address - Street 2:
Practice Address - City:PINETOPS
Practice Address - State:NC
Practice Address - Zip Code:27864-7188
Practice Address - Country:US
Practice Address - Phone:252-827-5231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13416363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant