=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720949290
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BREESHANNA R BROWN CNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2025
-----------------------------------------------------
Last Update Date | 12/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 904 E FREDERICK ST APT B
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64050-3134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-406-7612
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 904 E FREDERICK ST APT B
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64050-3134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-406-7612
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172A00000X
-----------------------------------------------------
Taxonomy Name | Driver
-----------------------------------------------------
License Number | 107039
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 107039
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number | 107039
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 373H00000X
-----------------------------------------------------
Taxonomy Name | Day Training/Habilitation Specialist
-----------------------------------------------------
License Number | 107039
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 3747A0650X
-----------------------------------------------------
Taxonomy Name | Attendant Care Provider
-----------------------------------------------------
License Number | 107039
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number | 107039
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 374T00000X
-----------------------------------------------------
Taxonomy Name | Religious Nonmedical Nursing Personnel
-----------------------------------------------------
License Number | 107039
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number | 107039
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #9
-----------------------------------------------------
Taxonomy Code | 310500000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Intermediate Care Facility
-----------------------------------------------------
License Number | 107039
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #10
-----------------------------------------------------
Taxonomy Code | 311500000X
-----------------------------------------------------
Taxonomy Name | Alzheimer Center (Dementia Center)
-----------------------------------------------------
License Number | 107039
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #11
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number | 107039
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #12
-----------------------------------------------------
Taxonomy Code | 372500000X
-----------------------------------------------------
Taxonomy Name | Chore Provider
-----------------------------------------------------
License Number | 107039
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #13
-----------------------------------------------------
Taxonomy Code | 372600000X
-----------------------------------------------------
Taxonomy Name | Adult Companion
-----------------------------------------------------
License Number | 107039
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #14
-----------------------------------------------------
Taxonomy Code | 376J00000X
-----------------------------------------------------
Taxonomy Name | Homemaker
-----------------------------------------------------
License Number | 107039
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #15
-----------------------------------------------------
Taxonomy Code | 376K00000X
-----------------------------------------------------
Taxonomy Name | Nurse's Aide
-----------------------------------------------------
License Number | 107039
-----------------------------------------------------
License Number State |
-----------------------------------------------------