Provider Demographics
NPI:1477888121
Name:TAYLOR, JENNIFER L (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
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 1:715 BROWN AVE.
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:NE
Mailing Address - Zip Code:68920-2132
Mailing Address - Country:US
Mailing Address - Phone:308-928-2103
Mailing Address - Fax:308-928-2560
Practice Address - Street 1:715 BROWN AVE.
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:NE
Practice Address - Zip Code:68920-2132
Practice Address - Country:US
Practice Address - Phone:308-928-2103
Practice Address - Fax:308-928-2560
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01349363A00000X
NE1609363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant