MEDICARE: KATHRYN GRACE TAYLOR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	20018	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00622806	OTHER	MS	RAILROAD MEDICARE PTAN
3	512I080155	OTHER	MS	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235339516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN GRACE TAYLOR M.D.

Provider Business Mailing Address
First Line	:	1220 N SHORE PKWY
Second Line	:	SUITE 6
City	:	BRANDON
State	:	MS
Zip	:	39047-6383
Country	:	US
Telephone Number	:	601-829-2939
Fax Number	:	601-829-2995

Provider Business Practice Location Address
First Line	:	1220 N SHORE PKWY
Second Line	:	SUITE 6
City	:	BRANDON
State	:	MS
Zip	:	39047-6383
Country	:	US
Telephone Number	:	601-829-2939
Fax Number	:	601-829-2995

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	04/08/2014

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Directions to “ KATHRYN GRACE TAYLOR M.D.” Practice Location

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