Provider Demographics
NPI:1235339516
Name:TAYLOR, KATHRYN GRACE (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GRACE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1220 N SHORE PKWY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6383
Mailing Address - Country:US
Mailing Address - Phone:601-829-2939
Mailing Address - Fax:601-829-2995
Practice Address - Street 1:1220 N SHORE PKWY
Practice Address - Street 2:SUITE 6
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-6383
Practice Address - Country:US
Practice Address - Phone:601-829-2939
Practice Address - Fax:601-829-2995
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20018207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06400753Medicaid
MSP00622806OtherRAILROAD MEDICARE PTAN
MS512I080155OtherMEDICARE PTAN