Provider Demographics
NPI:1639203250
Name:BROOKS-TAYLOR, LYN (MAT, RD, LDN, CHFS)
Entity Type:Individual
Prefix:MRS
First Name:LYN
Middle Name:
Last Name:BROOKS-TAYLOR
Suffix:
Gender:F
Credentials:MAT, RD, LDN, CHFS
Other - Prefix:MS
Other - First Name:LYN
Other - Middle Name:
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAT, RD, LDN, CHFS
Mailing Address - Street 1:2491 BROOKS RD
Mailing Address - Street 2:
Mailing Address - City:BELDEN
Mailing Address - State:MS
Mailing Address - Zip Code:38826-9548
Mailing Address - Country:US
Mailing Address - Phone:662-397-6053
Mailing Address - Fax:
Practice Address - Street 1:2491 BROOKS RD
Practice Address - Street 2:
Practice Address - City:BELDEN
Practice Address - State:MS
Practice Address - Zip Code:38826-9548
Practice Address - Country:US
Practice Address - Phone:662-397-6053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN1336133V00000X
MSD0455133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered