Individual
BRUCE A BRASWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1008 N MAIN ST, SIKESTON, MO 63801-5044
(573) 472-6001
(573) 472-6006
Mailing address
PO BOX 65, VANDALIA, IL 62471-0065
(618) 367-1921
(618) 283-4081
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
117542
MO
363L00000X
Nurse Practitioner
117542
MO
Other
Enumeration date
10/12/2006
Last updated
09/22/2009
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