Provider Demographics
NPI:1407334477
Name:KANE, TAYLOR DELOACH (NP)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:DELOACH
Last Name:KANE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 OLD TOWN CIR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-3628
Mailing Address - Country:US
Mailing Address - Phone:662-897-5853
Mailing Address - Fax:
Practice Address - Street 1:230 TRACE COLONY STE 2
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-8810
Practice Address - Country:US
Practice Address - Phone:601-992-3996
Practice Address - Fax:769-300-3112
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902477363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner