MEDICARE: KEANDRE 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
1	363A00000X	Physician Assistant	1216468	TX
2	363A00000X	Physician Assistant	PA18760	TX

General Provider Information

NPI Number	:	1851115448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEANDRE TAYLOR

Provider Business Mailing Address
First Line	:	125 E GRUBB DR STE 109
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-3402
Country	:	US
Telephone Number	:	972-285-6349
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 E GRUBB DR STE 109
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-3402
Country	:	US
Telephone Number	:	972-285-6349
Fax Number	:

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

Provider Enumeration Date	:	11/11/2024
Last Update Date	:	05/19/2025

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Directions to “ KEANDRE TAYLOR ” Practice Location

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