Healthcare Provider Details

I. General information

NPI: 1235093238
Provider Name (Legal Business Name): PRIVY HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1669 STATELINE RD W STE B
SOUTHAVEN MS
38671-1223
US

IV. Provider business mailing address

1669 STATELINE RD W STE B
SOUTHAVEN MS
38671-1223
US

V. Phone/Fax

Practice location:
  • Phone: 901-395-9485
  • Fax:
Mailing address:
  • Phone: 901-395-9485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHEMEKA CHANDRAE CHANDRAE TAYLOR
Title or Position: OWNER
Credential: NP-C
Phone: 662-874-7059