Healthcare Provider Details

I. General information

NPI: 1083124820
Provider Name (Legal Business Name): KAITLIN BROWN AGPCNP, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 E 121ST ST FL 5
NEW YORK NY
10035-3523
US

IV. Provider business mailing address

4215 CRESCENT STREET LUNA LIC, APT 9N
QUEENS NY
11101
US

V. Phone/Fax

Practice location:
  • Phone: 212-801-3300
  • Fax:
Mailing address:
  • Phone: 931-698-2448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number308486
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: