Healthcare Provider Details

I. General information

NPI: 1003422486
Provider Name (Legal Business Name): NICHOLAS PATRICK BROWN, DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E LAKE ST
MOUNT SHASTA CA
96067-2331
US

IV. Provider business mailing address

214 E LAKE ST
MOUNT SHASTA CA
96067-2331
US

V. Phone/Fax

Practice location:
  • Phone: 530-435-5048
  • Fax: 602-603-5084
Mailing address:
  • Phone: 530-435-5048
  • Fax: 602-603-5084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS PATRICK BROWN
Title or Position: CEO
Credential: DO
Phone: 530-435-5048