Provider Demographics
NPI:1427642057
Name:TAYLOR, SHEMEKA CHANDRAE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SHEMEKA
Middle Name:CHANDRAE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2149 STATELINE RD W
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-1222
Mailing Address - Country:US
Mailing Address - Phone:662-342-1112
Mailing Address - Fax:662-342-1116
Practice Address - Street 1:2149 STATELINE RD W
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-1222
Practice Address - Country:US
Practice Address - Phone:662-342-1112
Practice Address - Fax:662-342-1116
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME904461207R00000X
MS904461363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine