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General NPI Number Information
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NPI Number | 1770388878
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Entity Type | Individual
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Provider Name | TAYLOR ELISE WARDLAW FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 618 PEGRAM DR
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City | TUPELO
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State | MS
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Zip | 38801-6322
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Country | US
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Telephone | 662-844-6513
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Fax |
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Provider Business Mailing Address
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Address Line | 708 HIGHWAY 342
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City | PONTOTOC
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State | MS
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Zip | 38863-8934
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Country | US
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Telephone |
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 907203
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License Number State | MS
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