MEDICARE: KIYANA BROWN RN

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	163W00000X	Registered Nurse	248407	SC

General Provider Information

NPI Number	:	1962190488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIYANA BROWN RN

Provider Business Mailing Address
First Line	:	3180 THOMASINA MCPHERSON BLVD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-8283
Country	:	US
Telephone Number	:	843-745-2175
Fax Number	:	843-745-2182

Provider Business Practice Location Address
First Line	:	1087 E MONTAGUE AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-4826
Country	:	US
Telephone Number	:	843-745-7140
Fax Number	:

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

Provider Enumeration Date	:	04/25/2023
Last Update Date	:	04/25/2023

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