MEDICARE: AMANDA KYLE BROWN FNP

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	363LF0000X	Family Nurse Practitioner	AP08284	LA

General Provider Information

NPI Number	:	1275913360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA KYLE BROWN FNP

Provider Business Mailing Address
First Line	:	PO BOX 130
Second Line	:
City	:	NEW LLANO
State	:	LA
Zip	:	71461-0130
Country	:	US
Telephone Number	:	337-239-2207
Fax Number	:	337-239-2583

Provider Business Practice Location Address
First Line	:	919 S 10TH ST
Second Line	:
City	:	LEESVILLE
State	:	LA
Zip	:	71446-4613
Country	:	US
Telephone Number	:	337-239-2207
Fax Number	:	337-239-2583

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

Provider Enumeration Date	:	06/03/2015
Last Update Date	:	06/03/2015

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