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General NPI Number Information
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NPI Number | 1568859536
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Entity Type | Individual
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Provider Name | VALARIE J BROWN HAIR LOSS SPECIALIST
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Gender | Female
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Dates
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Enumeration Date | 04/17/2015
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Last Update Date | 04/28/2016
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Provider Practice Location Address
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Address Line | 105 W RIDGELAND AVE STE 4
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City | RIDGELAND
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State | MS
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Zip | 39157-2026
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Country | US
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Telephone | 601-810-1392
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Fax |
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Provider Business Mailing Address
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Address Line | 5847 CANTON PARK DR
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City | JACKSON
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State | MS
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Zip | 39211-3433
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Country | US
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Telephone | 601-810-1392
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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 | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | 00-61359
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License Number State | MS
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