Individual
KATHRYN GRACE TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1220 N SHORE PKWY, SUITE 6, BRANDON, MS 39047-6383
(601) 829-2939
(601) 829-2995
Mailing address
1220 N SHORE PKWY, SUITE 6, BRANDON, MS 39047-6383
(601) 829-2939
(601) 829-2995
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20018
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06400753
—
MS
01
—
512I080155
MEDICARE PTAN
MS
01
—
P00622806
RAILROAD MEDICARE PTAN
MS
Enumeration date
07/24/2007
Last updated
04/08/2014
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