Provider Demographics
NPI:1336157924
Name:TAYLOR, LEWIS D (PA-C)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:D
Last Name:TAYLOR
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 1:423 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66533-9803
Mailing Address - Country:US
Mailing Address - Phone:785-584-6705
Mailing Address - Fax:785-584-6817
Practice Address - Street 1:423 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66533-9803
Practice Address - Country:US
Practice Address - Phone:785-584-6705
Practice Address - Fax:785-584-6817
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00653363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100336570CMedicaid
KS100336570CMedicaid
KSS74359Medicare UPIN