Healthcare Provider Details

I. General information

NPI: 1750037073
Provider Name (Legal Business Name): ELEAINE TAYLOR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELEAINE BARRON

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 HARRISON BLVD STE 3680
OGDEN UT
84403-3289
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-4750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14267227-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15513
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: