Provider Demographics
NPI:1447478342
Name:TAYLOR, KAKECHA TIWANA (FNP)
Entity type:Individual
Prefix:MRS
First Name:KAKECHA
Middle Name:TIWANA
Last Name:TAYLOR
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5504 DEER TRAIL CV
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-9307
Mailing Address - Country:US
Mailing Address - Phone:662-832-1878
Mailing Address - Fax:
Practice Address - Street 1:3212 HIGHWAY 51 S STE A
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-2725
Practice Address - Country:US
Practice Address - Phone:662-429-9814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29839363LF0000X
MS904746363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily