Healthcare Provider Details

I. General information

NPI: 1871301473
Provider Name (Legal Business Name): KEYONNA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2024
Last Update Date: 12/28/2024
Certification Date: 12/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 CORMORANT CRES
MISSOURI CITY TX
77489-1195
US

IV. Provider business mailing address

3552 FM 1092 RD
MISSOURI CITY TX
77459-2203
US

V. Phone/Fax

Practice location:
  • Phone: 504-373-3595
  • Fax:
Mailing address:
  • Phone: 817-984-8655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: