Individual provider Active NPI

Taylor Hollander, PA-C, RDMS, RVT

  • Physician Assistant
  • Boonville, IN
National Provider Identifier
1407734874
Registry record updated Aug 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2733 S Yankeetown Rd
Boonville, IN 47601-8291
Phone
(812) 604-5408
NPI assigned
Aug 25, 2025
Last updated
Aug 25, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

2733 S Yankeetown Rd
Boonville, IN 47601-8291

Mailing address

2733 S Yankeetown Rd
Boonville, IN 47601-8291

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260424001276 IL Practitioner - Physician Assistant 4284101452 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4113 S Water Tower PL
Mount Vernon, IL 62864-6293
Phone (618) 244-9038

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 1

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1756080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756080000000",
    "number": "1407734874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2733 S YANKEETOWN RD",
            "city": "BOONVILLE",
            "state": "IN",
            "postal_code": "476018291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2733 S YANKEETOWN RD",
            "city": "BOONVILLE",
            "state": "IN",
            "postal_code": "476018291",
            "telephone_number": "812-604-5408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLANDER",
        "first_name": "TAYLOR",
        "credential": "PA-C, RDMS, RVT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-08-25",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boonville, IN

Sources for this page

Verify at the official NPI Registry.