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NPI Code Detail

MEDICARE: MRS. TAYLOR JOHNSON SMITH PA-C

MEDICARE: MRS. TAYLOR JOHNSON SMITH 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
1207RG0100XGastroenterology PhysicianTC866KY
2363AM0700XMedical Physician AssistantTC866KY
3363A00000XPhysician AssistantTC866KY

General Provider Information

NPI Number : 1730730516
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TAYLOR JOHNSON SMITH PA-C
Provider Business Mailing Address
First Line : PO BOX 776351
Second Line :
City : CHICAGO
State : IL
Zip : 60677-6351
Country : US
Telephone Number : 502-588-9490
Fax Number : 502-272-5116
Provider Business Practice Location Address
First Line : 3999 DUTCHMANS LN STE 7B
Second Line :
City : LOUISVILLE
State : KY
Zip : 40207-4742
Country : US
Telephone Number : 502-896-4711
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2019
Last Update Date : 10/27/2020

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Directions to “ MRS. TAYLOR JOHNSON SMITH PA-C” Practice Location

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