Healthcare Provider Details

I. General information

NPI: 1952958720
Provider Name (Legal Business Name): STACEY LYNN BROWN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 E MOUNTAIN VIEW RD STE 220
SCOTTSDALE AZ
85258-5172
US

IV. Provider business mailing address

40 S MAIN ST STE 1300
MEMPHIS TN
38103-5513
US

V. Phone/Fax

Practice location:
  • Phone: 717-449-0334
  • Fax:
Mailing address:
  • Phone: 901-422-7617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP020741
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25342
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: