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General NPI Number Information
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NPI Number | 1154629798
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Entity Type | Individual
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Provider Name | DAYTRAL M BROWN NP
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Gender | Female
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Dates
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Enumeration Date | 03/07/2011
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Last Update Date | 11/28/2021
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Provider Practice Location Address
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Address Line | 103A WOODBINE PL
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City | LONGVIEW
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State | TX
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Zip | 75601-2912
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Country | US
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Telephone | 903-212-7788
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Fax | 903-212-7789
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Provider Business Mailing Address
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Address Line | PO BOX 883
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City | LONGVIEW
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State | TX
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Zip | 75606-0883
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Country | US
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Telephone | 903-212-7788
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Fax | 903-212-7789
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP120067
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | 692645
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | AP120067
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License Number State | TX
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