Individual
DEONTRANESE TREVA TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
314 MAIN ST STE D, MONTICELLO, MS 39654-3702
(601) 587-4304
Mailing address
314 MAIN ST STE D, MONTICELLO, MS 39654-3702
(601) 587-4304
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
R865884
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R865884
MS
Other
Enumeration date
11/27/2012
Last updated
11/22/2023
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