Healthcare Provider Details

I. General information

NPI: 1174235725
Provider Name (Legal Business Name): LAURA A TAYLOR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9260 W SUNSET RD STE 200
LAS VEGAS NV
89148-4903
US

IV. Provider business mailing address

9260 W SUNSET RD STE 200
LAS VEGAS NV
89148-4903
US

V. Phone/Fax

Practice location:
  • Phone: 702-963-1231
  • Fax: 702-442-9309
Mailing address:
  • Phone: 702-963-1231
  • Fax: 702-302-4455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2740
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: