MEDICARE: TAYLOR ANNA SMITH

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	363AM0700X	Medical Physician Assistant	50.005932RX	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1159426	OTHER	OH	NCCPA

General Provider Information

NPI Number	:	1669031118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR ANNA SMITH

Provider Business Mailing Address
First Line	:	453 WATERBURY CT
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-5309
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	453 WATERBURY CT
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-5309
Country	:	US
Telephone Number	:	614-515-5244
Fax Number	:

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

Provider Enumeration Date	:	06/09/2019
Last Update Date	:	06/09/2019

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Directions to “ TAYLOR ANNA SMITH ” Practice Location

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