Provider Demographics
NPI:1194585216
Name:TAYLOR, ASHLEY
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 ANN DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:MS
Mailing Address - Zip Code:39039-6009
Mailing Address - Country:US
Mailing Address - Phone:662-763-7999
Mailing Address - Fax:
Practice Address - Street 1:34 ANN DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:MS
Practice Address - Zip Code:39039-6009
Practice Address - Country:US
Practice Address - Phone:662-763-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS334379372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion