Basic Information
| Provider Information | |||||||||
| NPI: | 1336157924 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | LEWIS | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 423 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ROSSVILLE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665339803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855846705 | ||||||||
| FaxNumber: | 7855846817 | ||||||||
| Practice Location | |||||||||
| Address1: | 423 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ROSSVILLE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665339803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855846705 | ||||||||
| FaxNumber: | 7855846817 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 01/26/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 15-00653 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 100336570C | 05 | KS | MEDICAID |