Provider Demographics
NPI:1487010823
Name:ISAAC, TAYLOR E (PA-C)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:E
Last Name:ISAAC
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:TATUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6600 S YALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:918-499-4855
Mailing Address - Fax:918-488-6098
Practice Address - Street 1:6465 S YALE AVE STE 910
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7811
Practice Address - Country:US
Practice Address - Phone:918-502-3200
Practice Address - Fax:918-502-3205
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2625363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant