Provider Demographics
NPI:1255877627
Name:KING, TAYLOR (PA-C)
Entity type:Individual
Prefix:MR
First Name:TAYLOR
Middle Name:
Last Name:KING
Suffix:
Gender:M
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 1:730 HAWTHORNE LN APT 443
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2182
Mailing Address - Country:US
Mailing Address - Phone:704-699-0596
Mailing Address - Fax:
Practice Address - Street 1:730 HAWTHORNE LN APT 443
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2182
Practice Address - Country:US
Practice Address - Phone:704-699-0596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06584363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical