Provider Demographics
NPI:1972755270
Name:TAYLOR, JASON ALLEN (RPA, INTERN)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ALLEN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:RPA, INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16029 DRY CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-3326
Mailing Address - Country:US
Mailing Address - Phone:502-500-6648
Mailing Address - Fax:502-297-8103
Practice Address - Street 1:16029 DRY CREEK WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-3326
Practice Address - Country:US
Practice Address - Phone:502-500-6648
Practice Address - Fax:502-297-8103
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY337010OtherARRT