MEDICARE: MRS. JENNIFER ANN TAYLOR RN

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	163WD0400X	Diabetes Educator Registered Nurse	862307	MS

General Provider Information

NPI Number	:	1831717347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER ANN TAYLOR RN

Provider Business Mailing Address
First Line	:	29436 MS HIGHWAY 32
Second Line	:
City	:	CHARLESTON
State	:	MS
Zip	:	38921-6602
Country	:	US
Telephone Number	:	662-515-7798
Fax Number	:	662-625-3024

Provider Business Practice Location Address
First Line	:	29436 MS HIGHWAY 32
Second Line	:
City	:	CHARLESTON
State	:	MS
Zip	:	38921-6602
Country	:	US
Telephone Number	:	662-515-7798
Fax Number	:	662-625-3024

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

Provider Enumeration Date	:	07/10/2020
Last Update Date	:	07/10/2020

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