=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023729605
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLISON KATE BROWN FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2022
-----------------------------------------------------
Last Update Date | 12/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1011 BOWLES AVE
-----------------------------------------------------
City | FENTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63026-2395
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-200-2713
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 347 STONEWALL DR
-----------------------------------------------------
City | EUREKA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63025-1644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-406-9100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 2022035169
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------