Individual provider Active NPI

Courtney Taylor Nicole Tullos, FNP

  • Family Nurse Practitioner
  • Clarksdale, MS
National Provider Identifier
1831037597
Registry record updated Mar 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
908298 Issued in MS
Practice address
1970 Hospital Dr
Clarksdale, MS 38614-7202
Phone
(662) 624-3580
Fax
(662) 621-3131
NPI assigned
Mar 24, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 908298 MS Primary

Addresses

Primary practice location

1970 Hospital Dr
Clarksdale, MS 38614-7202

Mailing address

10884 Kathy Rd
Collinsville, MS 39325-9708
Phone (601) 562-8663

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
908298MSMDFamily Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1774310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774396800000",
    "number": "1831037597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10884 KATHY RD",
            "city": "COLLINSVILLE",
            "state": "MS",
            "postal_code": "393259708",
            "telephone_number": "601-562-8663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1970 HOSPITAL DR",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386147202",
            "telephone_number": "662-624-3580",
            "fax_number": "662-621-3131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TULLOS",
        "first_name": "COURTNEY",
        "middle_name": "TAYLOR NICOLE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-03-24",
        "last_updated": "2026-03-25",
        "certification_date": "2026-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "908298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksdale, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.