Healthcare Provider Details

I. General information

NPI: 1912194101
Provider Name (Legal Business Name): NIKKI ANNTOINETTE BROWN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 TAUB LOOP
HOUSTON TX
77030-1608
US

IV. Provider business mailing address

2 GREENWAY PLZ SUITE 900
HOUSTON TX
77046-0297
US

V. Phone/Fax

Practice location:
  • Phone: 713-873-2000
  • Fax:
Mailing address:
  • Phone: 713-798-1835
  • Fax: 713-798-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1078253
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA05987
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: