Healthcare Provider Details

I. General information

NPI: 1326605841
Provider Name (Legal Business Name): MICA LAUREN BROWN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 TERRACE DR STE 200
MARION VA
24354-4393
US

IV. Provider business mailing address

1020 TERRACE DR STE 200
MARION VA
24354-4393
US

V. Phone/Fax

Practice location:
  • Phone: 276-783-7167
  • Fax: 276-783-6432
Mailing address:
  • Phone: 276-783-7167
  • Fax: 276-783-6432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24186975
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number171337
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: