MEDICARE: TAYLOR WATKINS PA

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	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant	085.008217	IL

General Provider Information

NPI Number	:	1609491547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR WATKINS PA

Provider Business Mailing Address
First Line	:	1112 TORINO LN
Second Line	:
City	:	FRANKLIN
State	:	IN
Zip	:	46131-7057
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1663 BELVIDERE RD
Second Line	:
City	:	BELVIDERE
State	:	IL
Zip	:	61008-9306
Country	:	US
Telephone Number	:	815-544-0040
Fax Number	:

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

Provider Enumeration Date	:	06/16/2020
Last Update Date	:	02/22/2021

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Directions to “ TAYLOR WATKINS PA” Practice Location

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