Jared Ross Taylor, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

FNP-363LF0000X Issued in NV

Practice address

1100 Wilford Hall Loop
Jbsa Lackland, TX 78236

Phone

(210) 292-4774

NPI assigned

Feb 26, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1235606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529452800000",
    "number": "1033359369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4755 W ANN RD",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890313424",
            "telephone_number": "702-645-0332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 WILFORD HALL LOOP",
            "city": "JBSA LACKLAND",
            "state": "TX",
            "postal_code": "78236",
            "telephone_number": "210-292-4774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "JARED",
        "middle_name": "ROSS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-26",
        "last_updated": "2018-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "FNP-363LF0000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARIZONA REGULATORY BOARD OF PHYSICIAN ASSISTANTS",
            "identifier": "4378",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEVADA STATE BOARD OF PHARMACY",
            "identifier": "CS22548",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "414670",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEVADA BOARD OF MEDICAL EXAMINERS",
            "identifier": "PA1142",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wongelawit Deldil Tadesse, DDS
• Paul Tagashira, PA-C
• Gerald Wayne Talcott, PHD
• Brenda Karina Tanyi, PHYSICIAN ASSISTANT
• April Jo Taylor, AU.D.
• Sean William Taylor, DMD
• Luis Carlos Teller
• Theresa Ten Haaf, DMD
• Mitzi Deeneen Thomas-Lawson, MSSW
• Shannon Nicole Thompson

• Physician Assistant in Jbsa Lackland, TX
• Providers in Jbsa Lackland, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; 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.