1164056529 NPI number — TAYLOR MECKENZIE CANTRELL PA-C

Table of content: TAYLOR MECKENZIE CANTRELL PA-C (NPI 1164056529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164056529 NPI number — TAYLOR MECKENZIE CANTRELL PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANTRELL
Provider First Name:
TAYLOR
Provider Middle Name:
MECKENZIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEPHENS
Provider Other First Name:
TAYLOR
Provider Other Middle Name:
MECKENZIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164056529
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2695 ROCKY MOUNTAIN AVE STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOVELAND
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80538-9071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-624-4123
Provider Business Mailing Address Fax Number:
970-490-4173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16222 W US HIGHWAY 24 STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODLAND PARK
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80863-8763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-686-0878
Provider Business Practice Location Address Fax Number:
719-365-7885
Provider Enumeration Date:
02/25/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA.0006183 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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