Healthcare Provider Details

I. General information

NPI: 1912545682
Provider Name (Legal Business Name): TREVOR BROWN DNP, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 16TH AVE E APT 205
SEATTLE WA
98112-5157
US

IV. Provider business mailing address

303 16TH AVE E APT 205
SEATTLE WA
98112-5157
US

V. Phone/Fax

Practice location:
  • Phone: 509-863-7360
  • Fax:
Mailing address:
  • Phone: 509-863-7360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61312677
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN60990828
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: