Healthcare Provider Details

I. General information

NPI: 1699095448
Provider Name (Legal Business Name): DAWN C TAYLOR PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 LINCOLN DR
SPRINGFIELD KY
40069-1578
US

IV. Provider business mailing address

445 LINCOLN DR
SPRINGFIELD KY
40069-1578
US

V. Phone/Fax

Practice location:
  • Phone: 859-336-7731
  • Fax: 859-336-7715
Mailing address:
  • Phone: 859-336-7731
  • Fax: 859-336-7715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31359
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA513
License Number StateKY

VIII. Authorized Official

Name: DAWN C TAYLOR
Title or Position: OWNER
Credential: MD
Phone: 859-336-7731