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General NPI Number Information
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NPI Number | 1952761355
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Entity Type | Individual
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Provider Name | BETTY BROWN
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Gender | Female
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Dates
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Enumeration Date | 02/26/2016
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 300 JOSEPH AVE
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City | HENDERSON
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State | TX
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Zip | 75654-4334
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Country | US
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Telephone | 903-658-4855
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Fax | 903-392-8915
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Provider Business Mailing Address
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Address Line | 300 JOSEPH AVE
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City | HENDERSON
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State | TX
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Zip | 75654-4334
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Country | US
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Telephone | 903-658-4855
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Fax | 903-392-8915
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | 126482
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 126482
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License Number State | TX
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