Provider Demographics
NPI:1770081788
Name:BIDDY, MARY BARRACK (PA-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BARRACK
Last Name:BIDDY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:BARRACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:778 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9300
Mailing Address - Country:US
Mailing Address - Phone:769-243-6141
Mailing Address - Fax:769-243-6141
Practice Address - Street 1:103 KEATING CIR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-4561
Practice Address - Country:US
Practice Address - Phone:985-705-3754
Practice Address - Fax:985-705-3754
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3545363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical