Provider Demographics
NPI:1306328588
Name:CURRALL, TAYLOR BLAIR (PA-C)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:BLAIR
Last Name:CURRALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:BLAIR
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:910-721-4230
Mailing Address - Fax:910-721-4239
Practice Address - Street 1:204 SMITH AVE
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-4458
Practice Address - Country:US
Practice Address - Phone:910-721-4230
Practice Address - Fax:910-721-4239
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3043363A00000X, 363AM0700X
NC363A00000X363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3043OtherPHYSICIAN ASSISTANT LICENSE