Healthcare Provider Details

I. General information

NPI: 1578878740
Provider Name (Legal Business Name): NICOLE ELIZABETH BROWN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE ELIZABETH KERN PA

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 SAM PERRY BLVD STE 314
FREDERICKSBURG VA
22401-4466
US

IV. Provider business mailing address

705 QUAIL CREEK DR
AMARILLO TX
79124-1608
US

V. Phone/Fax

Practice location:
  • Phone: 540-374-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110010578
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002420
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13285
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number002420
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: