Healthcare Provider Details

I. General information

NPI: 1558259911
Provider Name (Legal Business Name): KIERSTEN T BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 AVENTURA CT
RANDALLSTOWN MD
21133-4330
US

IV. Provider business mailing address

14 AVENTURA CT
RANDALLSTOWN MD
21133-4330
US

V. Phone/Fax

Practice location:
  • Phone: 443-468-2886
  • Fax:
Mailing address:
  • Phone: 443-468-2886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: