Healthcare Provider Details

I. General information

NPI: 1790890655
Provider Name (Legal Business Name): KAREN LYNN BROWN PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 W KALAMAZOO AVE
KALAMAZOO MI
49007-3334
US

IV. Provider business mailing address

418 W KALAMAZOO AVE
KALAMAZOO MI
49007-3334
US

V. Phone/Fax

Practice location:
  • Phone: 269-553-7037
  • Fax: 269-553-7106
Mailing address:
  • Phone: 269-553-7037
  • Fax: 269-553-7106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003287
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: