Healthcare Provider Details

I. General information

NPI: 1508235557
Provider Name (Legal Business Name): DENVER BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2015
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 STATE HIGHWAY 248 SUITE J
BRANSON MO
65616-9655
US

IV. Provider business mailing address

1440 STATE HIGHWAY 248 SUITE J
BRANSON MO
65616-9655
US

V. Phone/Fax

Practice location:
  • Phone: 417-239-0706
  • Fax: 417-239-0768
Mailing address:
  • Phone: 417-239-0706
  • Fax: 417-239-0768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0915614
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: