Healthcare Provider Details

I. General information

NPI: 1629635396
Provider Name (Legal Business Name): KENYATTA CARNELL BROWN APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 MIKE PADGETT HWY
AUGUSTA GA
30906-3815
US

IV. Provider business mailing address

1500 CALDWELL DR APT B
HEPHZIBAH GA
30815-6378
US

V. Phone/Fax

Practice location:
  • Phone: 706-432-4800
  • Fax:
Mailing address:
  • Phone: 706-589-2747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN239564
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: