Provider Demographics
NPI:1386461275
Name:JEFFERSON, TAYLOR CECILE ILLYANA
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:CECILE ILLYANA
Last Name:JEFFERSON
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 1:603 LADNER LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9537
Mailing Address - Country:US
Mailing Address - Phone:601-942-0465
Mailing Address - Fax:
Practice Address - Street 1:603 LADNER LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-9537
Practice Address - Country:US
Practice Address - Phone:601-942-0465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program