Healthcare Provider Details

I. General information

NPI: 1467121624
Provider Name (Legal Business Name): TAYLOR ELDORA MITCHELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 UNIVERSITY BLVD
GALVESTON TX
77555-5302
US

IV. Provider business mailing address

PO BOX 650859 DEPT 710
DALLAS TX
75265-5302
US

V. Phone/Fax

Practice location:
  • Phone: 281-338-0829
  • Fax:
Mailing address:
  • Phone: 409-747-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14964
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: