MEDICARE: NAOMI BROWN PMH NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP1448	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	061682	OTHER	ME	ANTHEM

General Provider Information

NPI Number	:	1366502486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI BROWN PMH NP

Provider Business Mailing Address
First Line	:	3801 SANTA ROSA DR
Second Line	:	STE 400
City	:	KINGMAN
State	:	AZ
Zip	:	86401-2311
Country	:	US
Telephone Number	:	928-753-9387
Fax Number	:	928-753-9404

Provider Business Practice Location Address
First Line	:	2215 HUALAPAI MOUNTAIN RD
Second Line	:	SUITE H AND I
City	:	KINGMAN
State	:	AZ
Zip	:	86401-8324
Country	:	US
Telephone Number	:	928-753-9387
Fax Number	:	928-753-9404

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	03/07/2023

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