Healthcare Provider Details

I. General information

NPI: 1376053660
Provider Name (Legal Business Name): TAYLOR COVINGTON LAVERY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 TATE SPRINGS RD
LYNCHBURG VA
24501-1109
US

IV. Provider business mailing address

503 CHURCH ST APT 3
LYNCHBURG VA
24504-1339
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-3101
  • Fax:
Mailing address:
  • Phone: 804-627-2851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110-005941
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: