Provider Demographics
NPI:1194515965
Name:EDWARD BROWN SPECIALTY PARTNERS OF MISSISSIPPI PLLC
Entity type:Organization
Organization Name:EDWARD BROWN SPECIALTY PARTNERS OF MISSISSIPPI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-934-7995
Mailing Address - Street 1:820 W 42ND ST STE 2300
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-5016
Mailing Address - Country:US
Mailing Address - Phone:720-544-3492
Mailing Address - Fax:
Practice Address - Street 1:1119 42ND AVE STE A
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2664
Practice Address - Country:US
Practice Address - Phone:877-230-7841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDWARD BROWN SPECIALTY PARTNERS OF MISSISSIPPI PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-07
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty