Provider Demographics
NPI:1548429798
Name:TAYLOR, MISTYE DAWNIELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:MISTYE
Middle Name:DAWNIELLE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:300 STONECREST BLVD
Mailing Address - Street 2:SUITE 490
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5688
Mailing Address - Country:US
Mailing Address - Phone:615-223-0200
Mailing Address - Fax:615-223-8704
Practice Address - Street 1:300 STONECREST BLVD
Practice Address - Street 2:SUITE 490
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5688
Practice Address - Country:US
Practice Address - Phone:615-223-0200
Practice Address - Fax:615-223-8704
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL30423174400000X
TN49895207VG0400X, 207VX0000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS116356Medicaid