1588124473 NPI number — KATHERINE ELIZABETH TAYLOR APRN, FNP-BC

Table of content: KATHERINE ELIZABETH TAYLOR APRN, FNP-BC (NPI 1588124473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588124473 NPI number — KATHERINE ELIZABETH TAYLOR APRN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
KATHERINE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRIPLETT
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588124473
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1872 HIGHWAY 16 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARTHAGE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39051-9128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-528-6639
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
768 AVERY BLVD N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGELAND
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39157-5219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-487-6482
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  902446 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com