Individual
BRADEN SHANE LIKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
Mailing address
127 SHILOH PKWY, BRANDON, MS 39042-1209
(479) 650-9942
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
T-5258
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/11/2020
Last updated
07/08/2024
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