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Individual
TAYLOR VICKERS
Active
Individual
TAYLOR VICKERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
745200
TX
363A00000X
Physician Assistant
Primary
4161079
ID
363A00000X
Physician Assistant
PA13966
TX
363AM0700X
Medical Physician Assistant
PA13966
TX
Other
Enumeration date
05/29/2020
Last updated
01/09/2025
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