Healthcare Provider Details

I. General information

NPI: 1114834363
Provider Name (Legal Business Name): ISABELLA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4229 U S HIGHWAY 11
HATTIESBURG MS
39402-8024
US

IV. Provider business mailing address

77 SAINT ANNES DR
HATTIESBURG MS
39401-8252
US

V. Phone/Fax

Practice location:
  • Phone: 601-477-4658
  • Fax: 855-948-4200
Mailing address:
  • Phone: 601-477-4658
  • Fax: 855-948-4200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2828041
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: