1992157002 NPI number — MARKITTA A BROWN APRN, FNP-DNP, PMHNP

Table of content: MARKITTA A BROWN APRN, FNP-DNP, PMHNP (NPI 1992157002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992157002 NPI number — MARKITTA A BROWN APRN, FNP-DNP, PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
MARKITTA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-DNP, PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWN
Provider Other First Name:
MARKITTA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN, DNP, PMHNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1992157002
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
53 OLD SALEM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONDON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40741-6722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-682-2439
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 BENNETT CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONDON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40741-2842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-682-2439
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2016

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: 363LP0808X , with the licence number:  2021029170 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X , with the licence number: 3010485 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 3010485 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7100433400 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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