Healthcare Provider Details

I. General information

NPI: 1265328058
Provider Name (Legal Business Name): EDWARD BROWN SPECIALTY PARTNERS OF MISSISSIPPI, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 HOSPITAL ST
PASCAGOULA MS
39581-5312
US

IV. Provider business mailing address

820 W 42ND ST STE 2300
SCOTTSBLUFF NE
69361-5016
US

V. Phone/Fax

Practice location:
  • Phone: 877-230-7841
  • Fax:
Mailing address:
  • Phone: 720-544-3492
  • Fax: 308-260-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KRYSTAL RICHARDSON
Title or Position: DIRECTOR REVENUE CYCLE MANAGEMENT
Credential:
Phone: 214-934-7995