Taylor Suzanne Wahl, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA57177 Issued in CA

Practice address

1235 Osos St # 100
San Luis Obispo, CA 93401-3619

Phone

(805) 549-0888

NPI assigned

Sep 16, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: twahl999936@direct.lhs.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Central Oregon Pediatric Associates

  • Pediatrics Physician
  • Bend, OR
  • NPI 1457337834
  NPD (past)
• Central Oregon Pediatric Associates Subspecialty

  • Pediatrics Physician
  • Bend, OR
  • NPI 1053153452

  Physician Assistant

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567123200000",
    "number": "1003364191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 OSOS ST # 100",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934013619",
            "telephone_number": "805-549-0888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 OSOS ST # 100",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934013619",
            "telephone_number": "805-549-0888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2730 SW Moody Ave # Cl5Pa",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972015042",
            "country_code": "US",
            "telephone_number": "503-494-3633",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAHL",
        "first_name": "TAYLOR",
        "middle_name": "SUZANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-16",
        "last_updated": "2019-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA57177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen J Waddell, PHD
• Tina L Waggoner
• Cherish Wagner
• Cortney Paige Wagner, M.F.T.
• Rachael Mae Wahl, LVN
• Rose Charlotte Wakeland
• Anna Katrina Walden
• Nancy J Walden, FNP
• Justine E Waldram, L.M.
• James Kirk Waldsmith, DVM

• Physician Assistant in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.