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NPI Code Detail

MEDICARE: TAYLOR CROSS PA-C

MEDICARE: TAYLOR CROSS 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
1390200000XStudent in an Organized Health Care Education/Training Program
2363A00000XPhysician Assistant14175025-1206UT

General Provider Information

NPI Number : 1801536669
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAYLOR CROSS PA-C
Provider Business Mailing Address
First Line : 1164 E HEMINGWAY DR
Second Line :
City : MURRAY
State : UT
Zip : 84121-1712
Country : US
Telephone Number : 386-288-6032
Fax Number :
Provider Business Practice Location Address
First Line : 1683 E HERMITAGE CIR
Second Line :
City : MURRAY
State : UT
Zip : 84121-2015
Country : US
Telephone Number : 386-288-6032
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2022
Last Update Date : 09/18/2024

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Directions to “ TAYLOR CROSS PA-C” Practice Location

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