Healthcare Provider Details

I. General information

NPI: 1396651543
Provider Name (Legal Business Name): CHRISTINA DIMATTIA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W 8TH ST STE B
JUNCTION CITY KS
66441-2460
US

IV. Provider business mailing address

2721 VALLEY DR
JUNCTION CITY KS
66441-1996
US

V. Phone/Fax

Practice location:
  • Phone: 785-307-2643
  • Fax:
Mailing address:
  • Phone: 785-307-2643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06860
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: