Provider Demographics
NPI:1871001685
Name:BRADY, MAYLEN MUSGROVE (PA-C)
Entity Type:Individual
Prefix:
First Name:MAYLEN
Middle Name:MUSGROVE
Last Name:BRADY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 TAYLOR OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MS
Mailing Address - Zip Code:38673-9510
Mailing Address - Country:US
Mailing Address - Phone:601-422-9988
Mailing Address - Fax:
Practice Address - Street 1:1515 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-4033
Practice Address - Country:US
Practice Address - Phone:662-238-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-15
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00354363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant