Healthcare Provider Details

I. General information

NPI: 1578874764
Provider Name (Legal Business Name): KIMBERLY ANN BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10019 REISTERSTOWN RD FL 3
OWINGS MILLS MD
21117-3902
US

IV. Provider business mailing address

2408 DUNCAN RD
JONESBORO AR
72401-0475
US

V. Phone/Fax

Practice location:
  • Phone: 443-450-9347
  • Fax:
Mailing address:
  • Phone: 870-243-7219
  • Fax: 870-972-9950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: