Healthcare Provider Details

I. General information

NPI: 1750677704
Provider Name (Legal Business Name): BRIAN K PADGETT NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S HOLLY AVE
COLLINS MS
39428-3894
US

IV. Provider business mailing address

2511 WEEPING WILLOW CIR
HATTIESBURG MS
39402-6092
US

V. Phone/Fax

Practice location:
  • Phone: 601-765-3180
  • Fax:
Mailing address:
  • Phone: 601-467-7326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR879065
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: