Individual
MARISSA P TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
714 GRAVOIS RD STE 210, FENTON, MO 63026-7723
(636) 660-9850
(636) 660-9851
Mailing address
PO BOX 23340, SAINT LOUIS, MO 63156-3340
(314) 851-1000
(314) 851-4477
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2010014127
MO
363AM0700X
Medical Physician Assistant
085003595
IL
Other
Enumeration date
09/21/2009
Last updated
08/15/2022
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