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General NPI Number Information
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NPI Number | 1629635396
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Entity Type | Individual
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Provider Name | KENYATTA CARNELL BROWN APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/28/2019
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Last Update Date | 05/28/2019
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Provider Practice Location Address
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Address Line | 3421 MIKE PADGETT HWY
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City | AUGUSTA
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State | GA
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Zip | 30906-3815
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Country | US
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Telephone | 706-432-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 CALDWELL DR APT B
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City | HEPHZIBAH
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State | GA
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Zip | 30815-6378
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Country | US
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Telephone | 706-589-2747
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN239564
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License Number State | GA
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