MEDICARE: MS. LAUREN ASHLEY TAYLOR 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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant	PA17314	TX

General Provider Information

NPI Number	:	1538894449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREN ASHLEY TAYLOR PA-C

Provider Business Mailing Address
First Line	:	18518 HARDY OAK BLVD STE 300
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4762
Country	:	US
Telephone Number	:	210-696-4327
Fax Number	:

Provider Business Practice Location Address
First Line	:	18518 HARDY OAK BLVD STE 300
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4762
Country	:	US
Telephone Number	:	210-696-4327
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2022
Last Update Date	:	11/08/2023

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