Provider Demographics
NPI:1326165218
Name:TAYLOR, DEBRA B (FNP)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:B
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2500 NORTH STATE STREET
Mailing Address - Street 2:DEPT OF ENDO
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5525
Mailing Address - Fax:601-984-5769
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:ENDOCRINOLOGY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5525
Practice Address - Fax:601-984-5769
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS782722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07872714Medicaid
MS396172YS8TMedicare PIN
MS500011467Medicare PIN
MS512I500053Medicare PIN
MSP01687355Medicare PIN