Provider Demographics
NPI:1194026815
Name:BROGDEN, HARMONY RAE (PA)
Entity Type:Individual
Prefix:
First Name:HARMONY
Middle Name:RAE
Last Name:BROGDEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HARMONY
Other - Middle Name:RAE
Other - Last Name:BROGDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2350 SCHILLINGER RD S
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-4177
Mailing Address - Country:US
Mailing Address - Phone:251-633-0123
Mailing Address - Fax:
Practice Address - Street 1:2350 SCHILLINGER RD S
Practice Address - Street 2:SUITE A
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4177
Practice Address - Country:US
Practice Address - Phone:251-633-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00139363AM0700X
ALPA760363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9802592OtherAETNA
MS04074780Medicaid
MS04074780Medicaid