Provider Demographics
NPI:1851899322
Name:COFFEY, TAYLOR COUNTISS (PA-C)
Entity type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:COUNTISS
Last Name:COFFEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:ANNE
Other - Last Name:COUNTISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:WALKER BAPTIST MEDICAL CENTER
Mailing Address - Street 2:3500 HIGHWAY 78 E.
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501
Mailing Address - Country:US
Mailing Address - Phone:205-387-4188
Mailing Address - Fax:
Practice Address - Street 1:3400 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8956
Practice Address - Country:US
Practice Address - Phone:205-387-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1150472363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical