Healthcare Provider Details

I. General information

NPI: 1316410152
Provider Name (Legal Business Name): MEGAN M BROWN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRILLIUM WAY
CORBIN KY
40701-8727
US

IV. Provider business mailing address

1 TRILLIUM WAY
CORBIN KY
40701-8727
US

V. Phone/Fax

Practice location:
  • Phone: 606-526-4449
  • Fax: 606-523-8521
Mailing address:
  • Phone: 606-526-4449
  • Fax: 606-523-8521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3013145
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: