Healthcare Provider Details

I. General information

NPI: 1588693188
Provider Name (Legal Business Name): REGINA BROWN CAROLINA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2719 N AIR FRESNO DR
FRESNO CA
93727-1547
US

IV. Provider business mailing address

21203 FOX WALK TRL
HUMBLE TX
77338-1492
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-3200
  • Fax:
Mailing address:
  • Phone: 913-378-3756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0430048
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301501199
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2003007992
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301501199
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberC-173074
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: