Healthcare Provider Details

I. General information

NPI: 1396114922
Provider Name (Legal Business Name): TAYLOR ALLISON LUKAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAYLOR ALLISON SIMMONS

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20440 N 27TH AVE
PHOENIX AZ
85027-3240
US

IV. Provider business mailing address

7500 N DREAMY DRAW DR STE 145
PHOENIX AZ
85020-4668
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-4545
  • Fax: 480-882-5017
Mailing address:
  • Phone: 480-882-4545
  • Fax: 480-882-5814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6209
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number6209
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: