Healthcare Provider Details

I. General information

NPI: 1528386794
Provider Name (Legal Business Name): KATHLEEN ANN BROWN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W ASH ST
DEMING NM
88030-4000
US

IV. Provider business mailing address

PO BOX 1259
DEMING NM
88031-1259
US

V. Phone/Fax

Practice location:
  • Phone: 305-304-1373
  • Fax:
Mailing address:
  • Phone: 305-304-1373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP01782
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: