Healthcare Provider Details

I. General information

NPI: 1134077548
Provider Name (Legal Business Name): TAYLOR RAPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 GOOD SAMARITAN WAY STE 420
MOUNT VERNON IL
62864-2478
US

IV. Provider business mailing address

19851 STATE ROUTE 177
HOYLETON IL
62803-1903
US

V. Phone/Fax

Practice location:
  • Phone: 618-899-4000
  • Fax:
Mailing address:
  • Phone: 618-322-2085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085012255
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: