Healthcare Provider Details

I. General information

NPI: 1972755270
Provider Name (Legal Business Name): JASON ALLEN TAYLOR RPA, INTERN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 09/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16029 DRY CREEK WAY
LOUISVILLE KY
40299-3326
US

IV. Provider business mailing address

16029 DRY CREEK WAY
LOUISVILLE KY
40299-3326
US

V. Phone/Fax

Practice location:
  • Phone: 502-500-6648
  • Fax: 502-297-8103
Mailing address:
  • Phone: 502-500-6648
  • Fax: 502-297-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: