1770507220 NPI number — KERRY K BROWN PSY.D.

Table of content: KERRY K BROWN PSY.D. (NPI 1770507220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770507220 NPI number — KERRY K BROWN PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
KERRY
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770507220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
621 GROVE ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANNON FALLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55009-1626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-353-0813
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 MAIN ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANNON FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55009-2044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-263-3344
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2006

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: 103T00000X , with the licence number:  LP 4375 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 116482 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2443480 . This is a "AMERICA'S PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 170233 . This is a "U-CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 11572753 . This is a "CAQH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2026310 . This is a "BEHAVIORAL HEALTHCARE PRO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 314P3BR . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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