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General NPI Number Information
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NPI Number | 1033094545
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Entity Type | Individual
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Provider Name | JEDSIA OMEGA BROWN
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Gender | Female
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 209 W POINTE DR STE D
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City | SWANSEA
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State | IL
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Zip | 62226-8310
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Country | US
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Telephone | 618-641-3588
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Fax |
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Provider Business Mailing Address
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Address Line | 320 STURBRIDGE VILLAGE DR
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City | HAZELWOOD
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State | MO
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Zip | 63042-2129
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Country | US
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Telephone | 314-683-0094
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2025032879
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License Number State | MO
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