Individual
TAYLOR NICOLE KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
8711 US 31, INDIANAPOLIS, IN 46227-6252
(317) 887-7771
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10004027A
IN
363A00000X
Physician Assistant
TC223
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300068641
—
IN
Enumeration date
02/15/2022
Last updated
06/13/2023
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