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General NPI Number Information
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NPI Number | 1831037597
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Entity Type | Individual
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Provider Name | COURTNEY TAYLOR NICOLE TULLOS FNP
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Gender | Female
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Dates
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Enumeration Date | 03/24/2026
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Last Update Date | 03/25/2026
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Provider Practice Location Address
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Address Line | 1970 HOSPITAL DR
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City | CLARKSDALE
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State | MS
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Zip | 38614-7202
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Country | US
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Telephone | 662-624-3580
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Fax | 662-621-3131
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Provider Business Mailing Address
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Address Line | 10884 KATHY RD
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City | COLLINSVILLE
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State | MS
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Zip | 39325-9708
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Country | US
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Telephone | 601-562-8663
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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 | 908298
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License Number State | MS
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