Healthcare Provider Details

I. General information

NPI: 1942167580
Provider Name (Legal Business Name): TAYLOR J TIPTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US AIR FORCE LOCATIONS
APO AA
39540
US

IV. Provider business mailing address

17017 CANARY PALM DR
DIBERVILLE MS
39540-3825
US

V. Phone/Fax

Practice location:
  • Phone: 267-273-9962
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number2510756
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: