Provider Demographics
NPI:1821033697
Name:TAYLOR, JESSICA D (PA-C, ATC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:CMR 469 BOX 772
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09227-0008
Mailing Address - Country:US
Mailing Address - Phone:314-590-6505
Mailing Address - Fax:
Practice Address - Street 1:3210 KLEBER KASERNE
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09227
Practice Address - Country:US
Practice Address - Phone:314-590-6505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer