MEDICARE: KRYSTAL DONAE BROWN CNM

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	163WX0002X	High-Risk Obstetric Registered Nurse	798239	TX
2	367A00000X	Advanced Practice Midwife	AP132845	TX

General Provider Information

NPI Number	:	1508399387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTAL DONAE BROWN CNM

Provider Business Mailing Address
First Line	:	1122 JACKSON ST
Second Line	:	APT. 401
City	:	DALLAS
State	:	TX
Zip	:	75202-5212
Country	:	US
Telephone Number	:	214-862-5830
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-5259
Country	:	US
Telephone Number	:	214-266-0130
Fax Number	:

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

Provider Enumeration Date	:	04/07/2017
Last Update Date	:	04/07/2017

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