=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578827739
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAKITA M. MURRIEL M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2012
-----------------------------------------------------
Last Update Date | 08/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4541 N STATE ST
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39206-5308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-560-3874
-----------------------------------------------------
Fax | 877-760-0717
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 109 HIDDEN HOLW
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39110-4558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 769-666-9162
-----------------------------------------------------
Fax | 877-760-0717
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 23087
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------