=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407367683
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROXANNE L BROWN APN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2017
-----------------------------------------------------
Last Update Date | 03/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1210 BRIARVILLE RD BLDG F
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37115-5136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-860-0704
-----------------------------------------------------
Fax | 615-860-8235
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1210 BRIARVILLE RD BLDG F
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37115-5136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-860-0704
-----------------------------------------------------
Fax | 615-860-8235
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 7525
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------