MEDICARE: STEFANIE TAYLOR CHRISTY DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	R889351	MS

General Provider Information

NPI Number	:	1386020113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFANIE TAYLOR CHRISTY DNP

Provider Business Mailing Address
First Line	:	56 DUTCH LN
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39702-5500
Country	:	US
Telephone Number	:	662-329-3808
Fax Number	:	662-329-1440

Provider Business Practice Location Address
First Line	:	3654B NEW HOPE RD
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39702-8521
Country	:	US
Telephone Number	:	662-329-1488
Fax Number	:	662-329-1440

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2015
Last Update Date	:	01/28/2019

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