Healthcare Provider Details

I. General information

NPI: 1609407469
Provider Name (Legal Business Name): CARISSA LANAE BROWN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9351 GRANT ST STE 110
THORNTON CO
80229-4364
US

IV. Provider business mailing address

270 PEACEFUL HILLS DR
BONNERDALE AR
71933-6793
US

V. Phone/Fax

Practice location:
  • Phone: 888-777-1945
  • Fax:
Mailing address:
  • Phone: 501-617-1548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number123836
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: