Provider Demographics
NPI:1164056529
Name:CANTRELL, TAYLOR MECKENZIE (PA-C)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MECKENZIE
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:MECKENZIE
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4123
Mailing Address - Fax:970-490-4173
Practice Address - Street 1:16222 W US HIGHWAY 24 STE 200
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-8763
Practice Address - Country:US
Practice Address - Phone:719-686-0878
Practice Address - Fax:719-365-7885
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
COPA.0006183363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical