Healthcare Provider Details

I. General information

NPI: 1821240813
Provider Name (Legal Business Name): SHERRY DALE BROWN I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NORTH STATE ST UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
JACKSON MS
39216-4505
US

IV. Provider business mailing address

126 POLE BRIDGE CV
BRANDON MS
39042-9243
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-9455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS3092
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: