Provider Demographics
NPI:1407368103
Name:RATHBUN, TAYLOR GALE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:GALE
Last Name:RATHBUN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:TAYLOR
Other - Middle Name:GALE
Other - Last Name:HURL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 714906
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45271-4906
Mailing Address - Country:US
Mailing Address - Phone:614-826-9266
Mailing Address - Fax:
Practice Address - Street 1:3062 KINGSDALE CTR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2020
Practice Address - Country:US
Practice Address - Phone:614-484-1940
Practice Address - Fax:614-484-1941
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH50.005454RXOtherLICENSE