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General NPI Number Information
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NPI Number | 1346136157
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Entity Type | Organization
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Legal Business Name | EDWARD BROWN SPECIALTY PARTNERS OF MISSISSIPPI, PLLC
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Dates
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Enumeration Date | 06/17/2025
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 2356 GROVE ST
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City | VICKSBURG
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State | MS
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Zip | 39183-2857
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Country | US
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Telephone | 601-538-8230
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Fax |
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Provider Business Mailing Address
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Address Line | 820 W 42ND ST STE 2300
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City | SCOTTSBLUFF
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State | NE
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Zip | 69361-5016
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR REVENUE CYCLE MANAGEMENT
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Name | KRYSTAL RICHARDSON
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Credential |
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Telephone | 214-934-7995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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