Provider Demographics
NPI:1093040057
Name:TAYLOR, THOMAS MATTHEW (FNP- BC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MATTHEW
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:FNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-9001
Mailing Address - Country:US
Mailing Address - Phone:662-862-5200
Mailing Address - Fax:662-862-5297
Practice Address - Street 1:1 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-9001
Practice Address - Country:US
Practice Address - Phone:662-862-5200
Practice Address - Fax:662-862-5297
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2011-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR869922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily