Healthcare Provider Details

I. General information

NPI: 1497125207
Provider Name (Legal Business Name): TAYLOR CASTON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 HARRISON ST
BATESVILLE AR
72501-8820
US

IV. Provider business mailing address

3443 HARRISON ST
BATESVILLE AR
72501-8820
US

V. Phone/Fax

Practice location:
  • Phone: 870-698-1635
  • Fax: 870-793-3196
Mailing address:
  • Phone: 870-698-1635
  • Fax: 870-793-3196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberR-T1544
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: