Healthcare Provider Details

I. General information

NPI: 1477118404
Provider Name (Legal Business Name): JESSICA TAYLOR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 PATIENT CARE DR STE A
LANSING MI
48911-4271
US

IV. Provider business mailing address

3955 PATIENT CARE DR STE A
LANSING MI
48911-4271
US

V. Phone/Fax

Practice location:
  • Phone: 517-374-7600
  • Fax: 885-480-9150
Mailing address:
  • Phone: 517-374-7600
  • Fax: 885-480-9150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601013782
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: