Provider Demographics
NPI:1710381264
Name:GOSTON, JAKEISHA TAYLOR (FNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:JAKEISHA
Middle Name:TAYLOR
Last Name:GOSTON
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6128 LAMB WOODS DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-9257
Mailing Address - Country:US
Mailing Address - Phone:901-677-3405
Mailing Address - Fax:901-441-8920
Practice Address - Street 1:6128 LAMB WOODS DR
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38135-9257
Practice Address - Country:US
Practice Address - Phone:901-677-3405
Practice Address - Fax:901-441-8920
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19161363LP0808X, 363LF0000X
MS902949363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health