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NPI Code Detail

MEDICARE: CORY TYLER BROWN FNP

MEDICARE:   CORY TYLER 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
1363LF0000XFamily Nurse Practitioner0024178307VA

General Provider Information

NPI Number : 1760025365
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORY TYLER BROWN FNP
Provider Business Mailing Address
First Line : PO BOX 426
Second Line :
City : CEDAR BLUFF
State : VA
Zip : 24609-0426
Country : US
Telephone Number : 276-963-0111
Fax Number :
Provider Business Practice Location Address
First Line : 1113 CEDAR VALLEY DR
Second Line :
City : CEDAR BLUFF
State : VA
Zip : 24609-9190
Country : US
Telephone Number : 276-963-0111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2019
Last Update Date : 10/26/2019

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Directions to “ CORY TYLER BROWN FNP” Practice Location

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