Healthcare Provider Details

I. General information

NPI: 1124512215
Provider Name (Legal Business Name): DEANNA S BROWN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2944 BRECKENRIDGE LN
LOUISVILLE KY
40220-1409
US

IV. Provider business mailing address

2944 BRECKENRIDGE LN
LOUISVILLE KY
40220-1409
US

V. Phone/Fax

Practice location:
  • Phone: 502-893-0159
  • Fax: 502-213-3892
Mailing address:
  • Phone: 502-893-0159
  • Fax: 502-213-3892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: