MEDICARE: SANTINA DIANNE BROWN MPHNP

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	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	2019015755	MO
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2025045753	MO

General Provider Information

NPI Number	:	1558193573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANTINA DIANNE BROWN MPHNP

Provider Business Mailing Address
First Line	:	2015 CUMBERLAND RD
Second Line	:
City	:	BATES CITY
State	:	MO
Zip	:	64011-8400
Country	:	US
Telephone Number	:	816-678-5748
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 CUMBERLAND RD
Second Line	:
City	:	BATES CITY
State	:	MO
Zip	:	64011-8400
Country	:	US
Telephone Number	:	816-678-5748
Fax Number	:

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

Provider Enumeration Date	:	08/19/2024
Last Update Date	:	01/12/2026

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