Healthcare Provider Details

I. General information

NPI: 1093888539
Provider Name (Legal Business Name): MICHELLE VAUGHN TAYLOR C. F. N. P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR STE 1250
JACKSON MS
39216-4609
US

IV. Provider business mailing address

PO BOX 23666
JACKSON MS
39225-3666
US

V. Phone/Fax

Practice location:
  • Phone: 601-200-2990
  • Fax: 601-200-5939
Mailing address:
  • Phone: 601-200-4749
  • Fax: 601-200-5929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR870165
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: