Provider Demographics
NPI:1609118546
Name:TAYLOR, KRISTY L (EDD, SLP)
Entity type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:EDD, SLP
Other - Prefix:MS
Other - First Name:KRISTY
Other - Middle Name:L
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:129 GREENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7833
Mailing Address - Country:US
Mailing Address - Phone:769-226-8807
Mailing Address - Fax:
Practice Address - Street 1:129 GREENRIDGE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-7833
Practice Address - Country:US
Practice Address - Phone:769-226-8807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202011665235Z00000X
TX108503235Z00000X
MS2022048851235Z00000X
MS4299235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05926263Medicaid