Provider Demographics
NPI:1861892424
Name:TAYLOR, ALICIA NOEL (PA-C, MPAS)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:NOEL
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:NOEL
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MPAS
Mailing Address - Street 1:401 PROCTOR BLVD
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-3543
Mailing Address - Country:US
Mailing Address - Phone:606-515-9134
Mailing Address - Fax:
Practice Address - Street 1:2212 JACKSBORO PIKE
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2903
Practice Address - Country:US
Practice Address - Phone:423-201-9287
Practice Address - Fax:423-201-9290
Is Sole Proprietor?:No
Enumeration Date:2014-09-01
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2568363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant