Provider Demographics
NPI:1962410019
Name:WHITE-TAYLOR, DOROTHY M (PHD, CFNP)
Entity type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:M
Last Name:WHITE-TAYLOR
Suffix:
Gender:F
Credentials:PHD, CFNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:516 BEAVERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-4416
Mailing Address - Country:US
Mailing Address - Phone:601-364-1209
Mailing Address - Fax:601-364-1456
Practice Address - Street 1:1500 E WOODROW WILSON AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5116
Practice Address - Country:US
Practice Address - Phone:601-364-1303
Practice Address - Fax:601-364-1456
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR547603M363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care