Healthcare Provider Details

I. General information

NPI: 1528694221
Provider Name (Legal Business Name): TAYLOR ANNE ABDALA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR ANNE GIBSON

II. Dates (important events)

Enumeration Date: 03/14/2020
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1373 N 10TH AVE
STAYTON OR
97383-2037
US

IV. Provider business mailing address

648 PARKER LOOP
SILVERTON OR
97381-8801
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-9522
  • Fax: 503-769-9530
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5005
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13290
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA224593
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: