Healthcare Provider Details

I. General information

NPI: 1831717347
Provider Name (Legal Business Name): JENNIFER ANN TAYLOR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29436 MS HIGHWAY 32
CHARLESTON MS
38921-6602
US

IV. Provider business mailing address

29436 MS HIGHWAY 32
CHARLESTON MS
38921-6602
US

V. Phone/Fax

Practice location:
  • Phone: 662-515-7798
  • Fax: 662-625-3024
Mailing address:
  • Phone: 662-515-7798
  • Fax: 662-625-3024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number862307
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: