Provider Demographics
NPI:1760612899
Name:TAYLOR, RACHEL MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
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:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:ROCK CAVE
Mailing Address - State:WV
Mailing Address - Zip Code:26234-0217
Mailing Address - Country:US
Mailing Address - Phone:304-924-6262
Mailing Address - Fax:304-924-5460
Practice Address - Street 1:ROUTE 4 & 20 S. INTERSECTION
Practice Address - Street 2:
Practice Address - City:ROCKCAVE
Practice Address - State:WV
Practice Address - Zip Code:26234
Practice Address - Country:US
Practice Address - Phone:304-924-6262
Practice Address - Fax:304-924-6699
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV471363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810015471Medicaid
WV1086565OtherNCCPA
WV471OtherWV PA LICENSE
WVPA83121Medicare PIN
WV471OtherWV PA LICENSE
WVPA83141Medicare PIN
WVPA83111Medicare PIN
WVPA83151Medicare PIN
WVPA83131Medicare PIN
WVPA83101Medicare PIN