MEDICARE: MRS. CRYSTAL D BROWN ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	1841P	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000046065	OTHER		BS
2	7528229	OTHER		AETNA
3	1841P	OTHER	KY	LICENSE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063494045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CRYSTAL D BROWN ARNP

Provider Business Mailing Address
First Line	:	140 NEWCOMB AVE
Second Line	:
City	:	MOUNT VERNON
State	:	KY
Zip	:	40456-2725
Country	:	US
Telephone Number	:	606-256-5176
Fax Number	:	606-256-5191

Provider Business Practice Location Address
First Line	:	140 NEWCOMB AVE
Second Line	:
City	:	MOUNT VERNON
State	:	KY
Zip	:	40456-2725
Country	:	US
Telephone Number	:	606-256-5176
Fax Number	:	606-256-5191

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	03/18/2025

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