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General NPI Number Information
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NPI Number | 1205671914
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Entity Type | Individual
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Provider Name | ANDREA TAYLOR PA
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Gender | Female
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Dates
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Enumeration Date | 06/26/2024
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 3650 CAPE CENTER DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-2139
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Country | US
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Telephone | 910-483-0049
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Fax | 910-339-8905
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Provider Business Mailing Address
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Address Line | 864 SATINWOOD CT
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City | FAYETTEVILLE
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State | NC
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Zip | 28312-8110
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Country | US
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Telephone | 636-696-3579
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-15401
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License Number State | NC
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