Individual
NICOLE I. TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1229 E SEMINOLE ST, SPRINGFIELD, MO 65804-2227
(417) 820-2064
(417) 820-8716
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2008007460
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00724807
RAILROAD MEDICARE
MO
Enumeration date
03/20/2008
Last updated
01/15/2010
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