Healthcare Provider Details

I. General information

NPI: 1679447551
Provider Name (Legal Business Name): TAIYO BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3662 MCCAIN PARK DR
NORTH LITTLE ROCK AR
72116-7847
US

IV. Provider business mailing address

3662 MCCAIN PARK DR
NORTH LITTLE ROCK AR
72116-7847
US

V. Phone/Fax

Practice location:
  • Phone: 501-333-4967
  • Fax: 501-333-4967
Mailing address:
  • Phone: 501-333-4967
  • Fax: 501-333-4967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: