Healthcare Provider Details

I. General information

NPI: 1265587216
Provider Name (Legal Business Name): DIANE R. TAYLOR CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 EARL FRYE BLVD SUITE A
AMORY MS
38821-5507
US

IV. Provider business mailing address

313 MEADOWOOD DR
AMORY MS
38821-4824
US

V. Phone/Fax

Practice location:
  • Phone: 662-256-9331
  • Fax: 662-256-9335
Mailing address:
  • Phone: 662-256-9331
  • Fax: 662-256-9335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberR146520
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: