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General NPI Number Information
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NPI Number | 1710617550
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Entity Type | Individual
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Provider Name | SAMANTHA TAYLOR PA
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Gender | Female
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Dates
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Enumeration Date | 06/14/2022
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 1021 NE 6TH ST
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City | GRANTS PASS
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State | OR
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Zip | 97526-1113
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Country | US
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Telephone | 541-507-1881
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Fax | 541-507-1560
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Provider Business Mailing Address
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Address Line | 3063 DELTA WATERS RD
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City | MEDFORD
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State | OR
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Zip | 97504-5834
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Country | US
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Telephone | 707-208-9425
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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 | PA209982
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License Number State | OR
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