Provider Demographics
NPI:1982119228
Name:TAYLOR, FELIX
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4541 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-5308
Mailing Address - Country:US
Mailing Address - Phone:601-533-7017
Mailing Address - Fax:769-333-9151
Practice Address - Street 1:4541 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-5308
Practice Address - Country:US
Practice Address - Phone:601-533-7017
Practice Address - Fax:769-333-9151
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902294363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05053844Medicaid