Basic Information
| Provider Information | |||||||||
| NPI: | 1689275455 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARKS | ||||||||
| FirstName: | TAYLOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 86 TAUNTON ST | ||||||||
| Address2: | |||||||||
| City: | PLAINVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027622131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089285211 | ||||||||
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| Practice Location | |||||||||
| Address1: | 86 TAUNTON ST | ||||||||
| Address2: | |||||||||
| City: | PLAINVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027622131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089285211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2020 | ||||||||
| LastUpdateDate: | 12/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 363A00000X | PA7731 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.