MEDICARE: TAYLOR FAULKNER PA

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	363AS0400X	Surgical Physician Assistant
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1679184410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR FAULKNER PA

Provider Business Mailing Address
First Line	:	216 FOUNTAIN CT STE 250
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-2510
Country	:	US
Telephone Number	:	859-276-5008
Fax Number	:	592-786-4018

Provider Business Practice Location Address
First Line	:	216 FOUNTAIN CT STE 250
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-2510
Country	:	US
Telephone Number	:	859-276-5008
Fax Number	:	592-786-4018

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

Provider Enumeration Date	:	08/14/2020
Last Update Date	:	04/19/2023

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Directions to “ TAYLOR FAULKNER PA” Practice Location

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