MEDICARE: TAYLOR LYNN KOVACH 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	363A00000X	Physician Assistant	8386	AZ

General Provider Information

NPI Number	:	1710546619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR LYNN KOVACH PA

Provider Business Mailing Address
First Line	:	1157 S CRISMON RD STE 101
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85208-2661
Country	:	US
Telephone Number	:	480-827-5730
Fax Number	:	480-827-5731

Provider Business Practice Location Address
First Line	:	1157 S CRISMON RD STE 101
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85208-2661
Country	:	US
Telephone Number	:	918-392-1707
Fax Number	:	317-428-1033

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

Provider Enumeration Date	:	06/13/2019
Last Update Date	:	05/09/2026

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