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General NPI Number Information
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NPI Number | 1548096829
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Entity Type | Individual
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Provider Name | KATELYNN NICOLE TAYLOR MSPA, PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/12/2024
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 17525 MEDICAL CENTER PKWY
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City | INDEPENDENCE
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State | MO
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Zip | 64057-1824
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Country | US
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Telephone | 816-994-3150
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Fax | 816-359-3044
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Provider Business Mailing Address
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Address Line | 17525 MEDICAL CENTER PKWY
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City | INDEPENDENCE
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State | MO
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Zip | 64057-1824
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Country | US
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Telephone | 816-994-3150
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Fax | 816-359-3044
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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 | 2024038711
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License Number State | MO
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