Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 901503 | MS |
NPI | 1023469244 |
---|---|
Provider Name | Mrs. Michelle Wright Taylor |
First Address | Gulfport, MS 39503-3485 |
Second Address | Gulfport, MS 39503-3485 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2016 |
Last Update Date | 05/12/2019 |