Healthcare Provider Details

I. General information

NPI: 1265191456
Provider Name (Legal Business Name): ERICA BROWN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 MOSIER PKWY
BROOKVILLE OH
45309-1750
US

IV. Provider business mailing address

98 MOSIER PKWY
BROOKVILLE OH
45309-1750
US

V. Phone/Fax

Practice location:
  • Phone: 937-833-4103
  • Fax: 901-873-0931
Mailing address:
  • Phone: 937-833-4103
  • Fax: 901-873-0931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0031299
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30438
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number110787
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: