Healthcare Provider Details

I. General information

NPI: 1336057538
Provider Name (Legal Business Name): TYNETTA LASHANA BROWN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TY BROWN FNP

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 DR MARTIN LUTHER KING JR BLVD
KANSAS CITY MO
64130-2807
US

IV. Provider business mailing address

3801 DR MARTIN LUTHER KING JR BLVD
KANSAS CITY MO
64130-2807
US

V. Phone/Fax

Practice location:
  • Phone: 816-923-5800
  • Fax:
Mailing address:
  • Phone: 816-923-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2012032127
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: