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General NPI Number Information
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NPI Number | 1730508128
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Entity Type | Individual
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Provider Name | JENNIFER BRAXTON-BROWN
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Gender | Female
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Dates
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Enumeration Date | 04/14/2014
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Last Update Date | 11/25/2016
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Provider Practice Location Address
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Address Line | 1 MEDICAL VILLAGE DR STE 258
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City | EDGEWOOD
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State | KY
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Zip | 41017-3403
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Country | US
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Telephone | 859-301-2211
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Fax | 859-301-2511
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Provider Business Mailing Address
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Address Line | 340 THOMAS MORE PKWY CHAPEL PLACE B STE 220
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City | CRESTVIEW HILLS
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State | KY
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Zip | 41017-5100
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Country | US
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Telephone | 859-301-2211
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Fax | 859-301-2511
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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 | 3010601
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 366887
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1117832
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License Number State | KY
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