Provider Demographics
NPI:1134889686
Name:SNELL, BROOKLYN PAIGE (PA-C)
Entity type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:PAIGE
Last Name:SNELL
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 1:1500 ALLISONA RD
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37060-4233
Mailing Address - Country:US
Mailing Address - Phone:615-598-1600
Mailing Address - Fax:
Practice Address - Street 1:7601 SOUTHCREST PKWY
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-4739
Practice Address - Country:US
Practice Address - Phone:662-772-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-26
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant