Healthcare Provider Details

I. General information

NPI: 1053937961
Provider Name (Legal Business Name): KAY ELIZABETH BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 N CLINTON ST
FORT WAYNE IN
46825-5886
US

IV. Provider business mailing address

9505 HARTZELL RD
FORT WAYNE IN
46816-9729
US

V. Phone/Fax

Practice location:
  • Phone: 260-408-2035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number28189178A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: