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NPI Code Detail

MEDICARE: TAYTUM RAE VERMILYEA PA-C

MEDICARE: TAYTUM RAE VERMILYEA 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
1363A00000XPhysician Assistant10488AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295573434
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAYTUM RAE VERMILYEA PA-C
Provider Business Mailing Address
First Line : PO BOX 10880
Second Line :
City : PRESCOTT
State : AZ
Zip : 86304-0880
Country : US
Telephone Number : 602-406-4786
Fax Number : 916-636-4358
Provider Business Practice Location Address
First Line : 1050 GAIL GARDNER WAY STE 300
Second Line :
City : PRESCOTT
State : AZ
Zip : 86305-1640
Country : US
Telephone Number : 928-717-5232
Fax Number : 928-717-5238
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2024
Last Update Date : 04/08/2026

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Directions to “ TAYTUM RAE VERMILYEA PA-C” Practice Location

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