Provider Demographics
NPI:1952695496
Name:TAYLOR, BRANDIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BRANDIE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 CLIFF GOOKIN BLVD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6749
Mailing Address - Country:US
Mailing Address - Phone:662-840-2131
Mailing Address - Fax:662-840-2522
Practice Address - Street 1:1265 CLIFF GOOKIN BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6749
Practice Address - Country:US
Practice Address - Phone:662-840-2131
Practice Address - Fax:662-840-2522
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR853130363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
302I504798Medicare PIN