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NPI Code Detail

MEDICARE: MICHAEL CASEY TAYLOR

MEDICARE: MICHAEL CASEY TAYLOR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner61395431WA

General Provider Information

NPI Number : 1295425460
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL CASEY TAYLOR
Provider Business Mailing Address
First Line : 11830 SE 219TH PL
Second Line :
City : KENT
State : WA
Zip : 98031-3926
Country : US
Telephone Number : 801-556-6884
Fax Number :
Provider Business Practice Location Address
First Line : 604 OAKESDALE AVE SW STE 102
Second Line :
City : RENTON
State : WA
Zip : 98057-5204
Country : US
Telephone Number : 253-372-7960
Fax Number : 253-372-7965
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2023
Last Update Date : 05/11/2023

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Directions to “ MICHAEL CASEY TAYLOR ” Practice Location

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