MEDICARE: TAYLOR BOAGNI PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA17271	TX

General Provider Information

NPI Number	:	1053096842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR BOAGNI PA-C

Provider Business Mailing Address
First Line	:	106 TOWNE RD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-6437
Country	:	US
Telephone Number	:	337-351-7693
Fax Number	:

Provider Business Practice Location Address
First Line	:	3720 WESTHEIMER RD STE 650
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-5277
Country	:	US
Telephone Number	:	713-301-3551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2023
Last Update Date	:	10/13/2024

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Directions to “ TAYLOR BOAGNI PA-C” Practice Location

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