Provider Demographics
NPI:1891500344
Name:TAYLOR-COOPER, LATOYA KIERA (NP)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:KIERA
Last Name:TAYLOR-COOPER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 VALLEY VISTA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-3510
Mailing Address - Country:US
Mailing Address - Phone:769-233-4385
Mailing Address - Fax:
Practice Address - Street 1:7048 OLD CANTON RD STE 2E
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1021
Practice Address - Country:US
Practice Address - Phone:601-992-9790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906838363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily