Healthcare Provider Details

I. General information

NPI: 1316537178
Provider Name (Legal Business Name): TAYLOR JO KING PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 10/19/2023
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 PIERCE ST STE 300
SIOUX CITY IA
51104-3765
US

IV. Provider business mailing address

1956 130TH ST
LAWTON IA
51030-8022
US

V. Phone/Fax

Practice location:
  • Phone: 712-234-8725
  • Fax: 712-234-8728
Mailing address:
  • Phone: 712-202-8396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number107223
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number107223
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number107223
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: