Provider Demographics
NPI:1669604831
Name:BASKIN, TAYLOR N (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:N
Last Name:BASKIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 E GRAND AVE # 150
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-3839
Mailing Address - Country:US
Mailing Address - Phone:307-223-2005
Mailing Address - Fax:
Practice Address - Street 1:514 E GRAND AVE # 150
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-3839
Practice Address - Country:US
Practice Address - Phone:307-223-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPA844363A00000X
TXPA12162363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant