Provider Demographics
NPI:1295425460
Name:TAYLOR, MICHAEL CASEY
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CASEY
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11830 SE 219TH PL
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-3926
Mailing Address - Country:US
Mailing Address - Phone:801-556-6884
Mailing Address - Fax:
Practice Address - Street 1:604 OAKESDALE AVE SW STE 102
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5204
Practice Address - Country:US
Practice Address - Phone:253-372-7960
Practice Address - Fax:253-372-7965
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61395431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily