Healthcare Provider Details

I. General information

NPI: 1922922038
Provider Name (Legal Business Name): JAKE RYAN BROWNING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 OLD MAIN # 216
STATE COLLEGE PA
16802-1503
US

IV. Provider business mailing address

201 OLD MAIN
UNIVERSITY PARK PA
16802-1503
US

V. Phone/Fax

Practice location:
  • Phone: 814-865-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: