Healthcare Provider Details

I. General information

NPI: 1760309637
Provider Name (Legal Business Name): TAYLOR JORDAN KASTOR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 WESTBROOK PLAZA DR
WINSTON SALEM NC
27103-2993
US

IV. Provider business mailing address

1665 WESTBROOK PLAZA DR
WINSTON SALEM NC
27103-2993
US

V. Phone/Fax

Practice location:
  • Phone: 336-760-8380
  • Fax: 336-760-8380
Mailing address:
  • Phone: 336-760-8380
  • Fax: 336-760-8380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0010-16764
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: