Individual provider · Type 1 NPI

Taylor Lynn Derrico, PA-C

Surgical Physician Assistant · Jackson, MS

NPI number 1164945218 Active

Practice location

501 Marshall St Ste 104
Jackson, MS 39202-1663

Call (601) 969-6404 Map

Fax (601) 973-4541

Mailing address

965 Ridge Lake Blvd Ste 103
Memphis, TN 38120-9446

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant 363A00000XPA00457 (MS)
Surgical Physician Assistant Primary 363AS0400XPA00457 (MS)

Surgical Physician Assistant: Definition to come...

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About NPI 1164945218

Taylor Lynn Derrico, PA-C's National Provider Identifier is 1164945218, issued on Jul 20, 2017. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Jackson, MS. The record was last updated on Nov 13, 2025.