Healthcare Provider Details

I. General information

NPI: 1194618215
Provider Name (Legal Business Name): PATRICK ANDREWS BRASELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 WINDSOR BLVD
COLUMBUS MS
39702-3143
US

IV. Provider business mailing address

443 CLARK CIR
WEST POINT MS
39773-3840
US

V. Phone/Fax

Practice location:
  • Phone: 662-241-5518
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS-5338
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: