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General NPI Number Information
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NPI Number | 1053716423
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Entity Type | Organization
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Legal Business Name | BROWN FAMILY MEDICAL CLINIC, LLC
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Dates
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Enumeration Date | 10/28/2014
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Last Update Date | 10/28/2014
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Provider Practice Location Address
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Address Line | 102 BUSINESS PARK DR SUITE G
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City | RIDGELAND
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State | MS
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Zip | 39157-6016
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Country | US
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Telephone | 601-842-3726
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Fax |
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Provider Business Mailing Address
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Address Line | 102 BUSINESS PARK DR SUITE G
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City | RIDGELAND
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State | MS
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Zip | 39157-6016
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Country | US
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Telephone | 601-842-3726
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MRS. SHARI RENIA BROWN
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Credential | FNP-BC
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Telephone | 601-842-3726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R860780
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License Number State | MS
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