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General NPI Number Information
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NPI Number | 1952034456
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Entity Type | Individual
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Provider Name | JUSTIN MICHAEL TAYLOR PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 07/03/2022
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 140 MAYFAIR RD STE 800
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City | HATTIESBURG
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State | MS
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Zip | 39402-1702
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Country | US
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Telephone | 601-909-9394
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Fax |
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Provider Business Mailing Address
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Address Line | 140 MAYFAIR RD STE 800
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City | HATTIESBURG
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State | MS
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Zip | 39402-1702
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Country | US
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Telephone | 601-909-9394
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 905392
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License Number State | MS
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