Healthcare Provider Details

I. General information

NPI: 1710239496
Provider Name (Legal Business Name): KIMBERLY L BROWNE ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 PINE DR
STE GENEVIEVE MO
63670-1446
US

IV. Provider business mailing address

PO BOX 366
STE GENEVIEVE MO
63670-0366
US

V. Phone/Fax

Practice location:
  • Phone: 573-883-7474
  • Fax: 573-883-7647
Mailing address:
  • Phone: 573-883-4473
  • Fax: 573-883-4472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2012024135
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2006024303
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: