Healthcare Provider Details

I. General information

NPI: 1194026815
Provider Name (Legal Business Name): HARMONY RAE BROGDEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HARMONY RAE BROGDEN PA

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 08/19/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 SCHILLINGER RD S SUITE A
MOBILE AL
36695-4177
US

IV. Provider business mailing address

2350 SCHILLINGER RD S SUITE A
MOBILE AL
36695-4177
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-0123
  • Fax:
Mailing address:
  • Phone: 251-633-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00139
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA760
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: