Provider Demographics
NPI:1457906653
Name:HALTER, TAYLOR GRACE (PA-C)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:GRACE
Last Name:HALTER
Suffix:
Gender:F
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 1:1000 CARONDELET DR
Mailing Address - Street 2:PROVIDER ENROLLMENT/PHYSICIANS BILLING DEPT
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114
Mailing Address - Country:US
Mailing Address - Phone:816-943-5744
Mailing Address - Fax:
Practice Address - Street 1:8940 STATE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1646
Practice Address - Country:US
Practice Address - Phone:913-596-1313
Practice Address - Fax:913-596-2422
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02633363A00000X
ARPA975363A00000X
ARPA-975363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program