Provider Demographics
NPI:1730223785
Name:TAYLOR, TY M (LSA,CSA,SA-C)
Entity type:Individual
Prefix:MR
First Name:TY
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LSA,CSA,SA-C
Other - Prefix:
Other - First Name:TY
Other - Middle Name:M
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSA,CSA,SA-C
Mailing Address - Street 1:8321 ALDEN
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215
Mailing Address - Country:US
Mailing Address - Phone:816-522-7899
Mailing Address - Fax:
Practice Address - Street 1:8321 ALDEN ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-4213
Practice Address - Country:US
Practice Address - Phone:816-522-7899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2018-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3618246ZC0007X, 246ZS0400X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0400XSpecialist/Technologist, OtherSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical