Healthcare Provider Details

I. General information

NPI: 1205823465
Provider Name (Legal Business Name): JENNIFER LYNN BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 BECKLEY CROSSING SHPG CTR
BECKLEY WV
25801-7110
US

IV. Provider business mailing address

176 MEDICAL CENTER DR
RAINELLE WV
25962-1064
US

V. Phone/Fax

Practice location:
  • Phone: 304-252-6639
  • Fax: 304-252-6681
Mailing address:
  • Phone: 304-438-6188
  • Fax: 304-438-6819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20718
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: