Healthcare Provider Details

I. General information

NPI: 1174410229
Provider Name (Legal Business Name): TRAVIS REGINALD BROWN II DNP, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 SAN MARIN DR STE B150
NOVATO CA
94945-1362
US

IV. Provider business mailing address

505 SAN MARIN DR STE B150
NOVATO CA
94945-1362
US

V. Phone/Fax

Practice location:
  • Phone: 415-761-9490
  • Fax:
Mailing address:
  • Phone: 415-761-9490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95038276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: