Provider Demographics
NPI:1689314940
Name:GREEN, TAYLOR ANN (PA STUDENT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ANN
Last Name:GREEN
Suffix:
Gender:F
Credentials:PA STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 ARCADIA LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25312-5733
Mailing Address - Country:US
Mailing Address - Phone:304-389-6797
Mailing Address - Fax:
Practice Address - Street 1:49 ARCADIA LN
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25312-5733
Practice Address - Country:US
Practice Address - Phone:304-389-6797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant