Provider Demographics
NPI:1659775906
Name:CAYLOR, NATALIE (PA-C)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:CAYLOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:REAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:418 S GAY ST STE 103
Mailing Address - Street 2:PHOENIX BLDG.
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37902-1127
Mailing Address - Country:US
Mailing Address - Phone:865-525-4520
Mailing Address - Fax:865-525-4920
Practice Address - Street 1:418 S GAY ST
Practice Address - Street 2:PHOENIX BLDG.
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37902-1134
Practice Address - Country:US
Practice Address - Phone:123-456-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2655363AM0700X
TN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ009118Medicaid