Healthcare Provider Details

I. General information

NPI: 1790003044
Provider Name (Legal Business Name): SHARI R. BROWN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2860 MCDOWELL ROAD EXT
JACKSON MS
39204-4238
US

IV. Provider business mailing address

156 CHESTNUT DR
BRANDON MS
39047-7462
US

V. Phone/Fax

Practice location:
  • Phone: 601-372-1117
  • Fax: 601-373-3004
Mailing address:
  • Phone: 601-992-3274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR860780
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: