Provider Demographics
NPI:1003168857
Name:BROWN, LARAH (NP)
Entity Type:Individual
Prefix:MRS
First Name:LARAH
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 W CAMP WISDOM RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-2605
Mailing Address - Country:US
Mailing Address - Phone:469-966-9660
Mailing Address - Fax:877-667-6112
Practice Address - Street 1:3209 W CAMP WISDOM RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2605
Practice Address - Country:US
Practice Address - Phone:469-966-9660
Practice Address - Fax:877-667-6112
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122454363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health