Healthcare Provider Details

I. General information

NPI: 1568353548
Provider Name (Legal Business Name): TERRY ELLERY BROWN PSS, CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 BURGESS AVE
LEXINGTON KY
40511-1571
US

IV. Provider business mailing address

736 BURGESS AVE
LEXINGTON KY
40511-1571
US

V. Phone/Fax

Practice location:
  • Phone: 859-913-0372
  • Fax:
Mailing address:
  • Phone: 859-913-0372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: