Healthcare Provider Details

I. General information

NPI: 1710546619
Provider Name (Legal Business Name): TAYLOR LYNN KOVACH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1157 S CRISMON RD STE 101
MESA AZ
85208-2661
US

IV. Provider business mailing address

1157 S CRISMON RD STE 101
MESA AZ
85208-2661
US

V. Phone/Fax

Practice location:
  • Phone: 480-827-5730
  • Fax: 480-827-5731
Mailing address:
  • Phone: 480-827-5730
  • Fax: 480-827-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8386
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: