1225054174 NPI number — MRS. BRENDA LEANNE BROWN MASTER OF SCIENCE

Table of content: MRS. BRENDA LEANNE BROWN MASTER OF SCIENCE (NPI 1225054174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225054174 NPI number — MRS. BRENDA LEANNE BROWN MASTER OF SCIENCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
BRENDA
Provider Middle Name:
LEANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MASTER OF SCIENCE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCOTT
Provider Other First Name:
BRENDA
Provider Other Middle Name:
LEANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MASTER OF SCIENCE L
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225054174
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
592 HIGHWAY 160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOUNTAIN HILL
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71642-9232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-940-0222
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
592 HIGHWAY 160
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOUNTAIN HILL
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71642-9232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-940-0222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  05-5E , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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