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NPI Code Detail

MEDICARE: TAYLOR MICHELLE TANNER PA-C

MEDICARE: TAYLOR MICHELLE TANNER PA-C
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
1363A00000XPhysician Assistant324793LA

General Provider Information

NPI Number : 1518566025
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAYLOR MICHELLE TANNER PA-C
Provider Business Mailing Address
First Line : 128 NEUROSCIENCE CT
Second Line :
City : GRAY
State : LA
Zip : 70359-5209
Country : US
Telephone Number : 985-917-3007
Fax Number : 985-917-3010
Provider Business Practice Location Address
First Line : 128 NEUROSCIENCE CT
Second Line :
City : GRAY
State : LA
Zip : 70359-5209
Country : US
Telephone Number : 985-917-3007
Fax Number : 985-917-3010
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2020
Last Update Date : 10/26/2020

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Directions to “ TAYLOR MICHELLE TANNER PA-C” Practice Location

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