Provider Demographics
NPI:1740533280
Name:DRODDY, BARBRA ELLEN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BARBRA
Middle Name:ELLEN
Last Name:DRODDY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BARBRA
Other - Middle Name:ELLEN
Other - Last Name:LEAHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:11295 E TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503
Mailing Address - Country:US
Mailing Address - Phone:228-864-3300
Mailing Address - Fax:228-864-3333
Practice Address - Street 1:11295 E TAYLOR RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503
Practice Address - Country:US
Practice Address - Phone:228-864-3300
Practice Address - Fax:228-864-3333
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00350363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant