Provider Demographics
NPI:1770549891
Name:TAYLOR, STEPHANIE LEE (PA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1845
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-1845
Mailing Address - Country:US
Mailing Address - Phone:704-871-1155
Mailing Address - Fax:704-878-6594
Practice Address - Street 1:705 GAITHER RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-3450
Practice Address - Country:US
Practice Address - Phone:704-871-1155
Practice Address - Fax:704-878-6594
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2016-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC104102363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant