Provider Demographics
NPI:1699774810
Name:TAYLOR, ANGELA RIDGE (FNP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RIDGE
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 1:961 SOUTH GLOSTER STREET
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801
Mailing Address - Country:US
Mailing Address - Phone:662-844-9166
Mailing Address - Fax:662-844-0170
Practice Address - Street 1:961 SOUTH GLOSTER STREET
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801
Practice Address - Country:US
Practice Address - Phone:662-844-9166
Practice Address - Fax:662-844-0170
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR853671363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0126044Medicaid
MSP65168Medicare UPIN
MS0126044Medicaid