Healthcare Provider Details

I. General information

NPI: 1578346359
Provider Name (Legal Business Name): TAYLOR SCOTT JENKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E SHOW LOW LAKE RD
SHOW LOW AZ
85901-7831
US

IV. Provider business mailing address

1148 W BASELINE RD
MESA AZ
85210-5971
US

V. Phone/Fax

Practice location:
  • Phone: 928-537-6820
  • Fax:
Mailing address:
  • Phone: 480-559-3149
  • Fax: 855-822-6349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number296661
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: