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General NPI Number Information
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NPI Number | 1093192791
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Entity Type | Individual
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Provider Name | MICHELLE BROWN
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Gender | Female
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Dates
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Enumeration Date | 05/01/2015
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Last Update Date | 09/12/2016
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Provider Practice Location Address
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Address Line | 30 YORKSHIRE PKWY
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City | GULFPORT
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State | MS
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Zip | 39503-4018
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Country | US
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Telephone | 228-563-3501
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Fax | 228-206-6444
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Provider Business Mailing Address
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Address Line | 30 YORKSHIRE PKWY
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City | GULFPORT
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State | MS
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Zip | 39503-4018
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Country | US
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Telephone | 228-563-3501
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Fax | 228-206-6444
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | DOM05768
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | DOM05768
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | DOM05768
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License Number State | MS
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