Healthcare Provider Details

I. General information

NPI: 1912097726
Provider Name (Legal Business Name): SCOTT D. BROWN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 FREY ST
ASHLAND CITY TN
37015-1734
US

IV. Provider business mailing address

342 FREY ST
ASHLAND CITY TN
37015-1734
US

V. Phone/Fax

Practice location:
  • Phone: 615-792-1199
  • Fax: 615-792-9331
Mailing address:
  • Phone: 615-792-1199
  • Fax: 615-792-9331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD28452
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1735
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN14199
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN12526
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8049
License Number StateTN

VIII. Authorized Official

Name: MRS. KATHRYN V BROWN
Title or Position: ADMINISTRATOR
Credential:
Phone: 615-792-1199