Healthcare Provider Details

I. General information

NPI: 1538298203
Provider Name (Legal Business Name): DELIA TAYLOR EMERSON RN, MSN, CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-1196
  • Fax: 601-815-0434
Mailing address:
  • Phone: 601-815-1196
  • Fax: 601-815-0434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR772541
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: