Healthcare Provider Details

I. General information

NPI: 1093593758
Provider Name (Legal Business Name): JACQUELINE BROWN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 UNION AVE STE 1000
MEMPHIS TN
38104-7501
US

IV. Provider business mailing address

1331 UNION AVE STE 1000
MEMPHIS TN
38104-7501
US

V. Phone/Fax

Practice location:
  • Phone: 901-289-2582
  • Fax:
Mailing address:
  • Phone: 901-289-2582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number95073
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number95073
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: