Healthcare Provider Details

I. General information

NPI: 1477751402
Provider Name (Legal Business Name): DARREL LEE BROWN CFA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 AUDUBON DR
MANDEVILLE LA
70471
US

IV. Provider business mailing address

230 AUDUBON DR
MANDEVILLE LA
70471
US

V. Phone/Fax

Practice location:
  • Phone: 985-845-1501
  • Fax: 985-845-1601
Mailing address:
  • Phone: 985-845-1501
  • Fax: 985-845-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number075250
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: