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NPI Code Detail

MEDICARE: MS. TAYLOR JO KING PA-C

MEDICARE: MS. TAYLOR JO KING 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
1363AM0700XMedical Physician Assistant107223IA
2363AS0400XSurgical Physician Assistant107223IA
3363A00000XPhysician Assistant107223IA

General Provider Information

NPI Number : 1316537178
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TAYLOR JO KING PA-C
Provider Business Mailing Address
First Line : 1956 130TH ST
Second Line :
City : LAWTON
State : IA
Zip : 51030-8022
Country : US
Telephone Number : 712-202-8396
Fax Number :
Provider Business Practice Location Address
First Line : 2730 PIERCE ST STE 300
Second Line :
City : SIOUX CITY
State : IA
Zip : 51104-3765
Country : US
Telephone Number : 712-234-8725
Fax Number : 712-234-8728
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2021
Last Update Date : 10/19/2023

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