Healthcare Provider Details

I. General information

NPI: 1619233913
Provider Name (Legal Business Name): JESSICA JEANNE BROWN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 06/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 WEITZEL ST STE 101
TIMNATH CO
80547
US

IV. Provider business mailing address

1804 W MOUNTAIN AVE
FORT COLLINS CO
80521-2346
US

V. Phone/Fax

Practice location:
  • Phone: 970-494-2626
  • Fax: 970-494-2627
Mailing address:
  • Phone: 405-802-9631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberPA.0004356
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: