MEDICARE: ANDREA ALICIA BROWN

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	103K00000X	Behavior Analyst		KS
2	3747P1801X	Personal Care Attendant		NE

General Provider Information

NPI Number	:	1093546335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA ALICIA BROWN

Provider Business Mailing Address
First Line	:	1812 KATIE ROSE TRL
Second Line	:
City	:	JUNCTION CITY
State	:	KS
Zip	:	66441-2277
Country	:	US
Telephone Number	:	402-707-0946
Fax Number	:

Provider Business Practice Location Address
First Line	:	1812 KATIE ROSE TRL
Second Line	:
City	:	JUNCTION CITY
State	:	KS
Zip	:	66441-2277
Country	:	US
Telephone Number	:	402-707-0946
Fax Number	:

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

Provider Enumeration Date	:	08/09/2024
Last Update Date	:	10/03/2025

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