MEDICARE: MRS. LARAH BROWN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	AP122454	TX

General Provider Information

NPI Number	:	1003168857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LARAH BROWN NP

Provider Business Mailing Address
First Line	:	3209 W CAMP WISDOM RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-2605
Country	:	US
Telephone Number	:	469-966-9660
Fax Number	:	877-667-6112

Provider Business Practice Location Address
First Line	:	3209 W CAMP WISDOM RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-2605
Country	:	US
Telephone Number	:	469-966-9660
Fax Number	:	877-667-6112

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2012
Last Update Date	:	11/03/2023

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