Healthcare Provider Details

I. General information

NPI: 1912865262
Provider Name (Legal Business Name): KHUSHI PRAKASH PATEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CAPITOL ST
CLINTON MS
39056-4026
US

IV. Provider business mailing address

38 CANEBRAKE BLVD
HATTIESBURG MS
39402-8709
US

V. Phone/Fax

Practice location:
  • Phone: 601-925-3000
  • Fax:
Mailing address:
  • Phone: 601-818-8047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: