Basic Information
| Provider Information | |||||||||
| NPI: | 1134889686 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SNELL | ||||||||
| FirstName: | BROOKLYN | ||||||||
| MiddleName: | PAIGE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 ALLISONA RD | ||||||||
| Address2: | |||||||||
| City: | EAGLEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370604233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6155981600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7601 SOUTHCREST PKWY | ||||||||
| Address2: | |||||||||
| City: | SOUTHAVEN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386714739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6627724000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2021 | ||||||||
| LastUpdateDate: | 12/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.