Healthcare Provider Details

I. General information

NPI: 1104751114
Provider Name (Legal Business Name): KRYSTAL R BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 TOWN AND COUNTRY WAY APT 224
HOUSTON TX
77024-1181
US

IV. Provider business mailing address

539 W COMMERCE ST # 4901
DALLAS TX
75208-1953
US

V. Phone/Fax

Practice location:
  • Phone: 832-306-3318
  • Fax:
Mailing address:
  • Phone: 832-306-3318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1246898
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: