Healthcare Provider Details

I. General information

NPI: 1982738175
Provider Name (Legal Business Name): MICHELLE DENISE BROWN RNC, WHCNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 CENTRAL AVE
FILLMORE CA
93015-1920
US

IV. Provider business mailing address

600 SUN TEMPLE DR
MADISON AL
35758-8643
US

V. Phone/Fax

Practice location:
  • Phone: 805-524-4926
  • Fax:
Mailing address:
  • Phone: 256-288-3333
  • Fax: 256-288-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN100598
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP04840
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number16996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: