Provider Demographics
NPI:1922989748
Name:WATERS, TAYLOR KATHRYN (PA-C)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:KATHRYN
Last Name:WATERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2727 HEARNE AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3918
Mailing Address - Country:US
Mailing Address - Phone:318-631-6400
Mailing Address - Fax:318-631-0300
Practice Address - Street 1:PO BOX 112
Practice Address - Street 2:
Practice Address - City:WILLISVILLE
Practice Address - State:AR
Practice Address - Zip Code:71864-0112
Practice Address - Country:US
Practice Address - Phone:870-904-6577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant