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General NPI Number Information
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NPI Number | 1710381264
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Entity Type | Individual
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Provider Name | JAKEISHA TAYLOR GOSTON FNP, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 10/13/2014
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 20 N WASHINGTON AVE
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City | BROWNSVILLE
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State | TN
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Zip | 38012-2555
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Country | US
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Telephone | 901-677-3405
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Fax | 901-441-8920
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Provider Business Mailing Address
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Address Line | 6025 STAGE RD STE 42-440
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City | BARTLETT
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State | TN
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Zip | 38134-8374
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Country | US
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Telephone | 901-677-3405
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Fax | 901-441-8920
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 19161
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 902949
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 19161
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License Number State | TN
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