Healthcare Provider Details

I. General information

NPI: 1295332302
Provider Name (Legal Business Name): TAKINYA RANEESE BINION MINOR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 LEXINGTON DR STE 100
MADISON MS
39110-6952
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD
MEMPHIS TN
38120-9401
US

V. Phone/Fax

Practice location:
  • Phone: 601-973-1688
  • Fax:
Mailing address:
  • Phone: 901-227-4692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number903839
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number903839
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: