Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 903845 | MS |
NPI | 1003443458 |
---|---|
Provider Name | Nicole Sherice Taylor |
First Address | Tupelo, MS 38801-0313 |
Second Address | Tupelo, MS 38801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2020 |
Last Update Date | 25/03/2020 |