Healthcare Provider Details

I. General information

NPI: 1720445562
Provider Name (Legal Business Name): REBECCA GAHAN BROWN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N ROADRUNNER PKWY
LAS CRUCES NM
88011
US

IV. Provider business mailing address

1919 LATHROP ST STE 104
FAIRBANKS AK
99701-5937
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-6440
  • Fax: 575-556-6440
Mailing address:
  • Phone: 907-341-4509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number233878
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA2017-0017
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: