Provider Demographics
NPI:1003834292
Name:BROWN, JERI SWAIM (FNP)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:SWAIM
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JERI
Other - Middle Name:LYNN
Other - Last Name:SWAIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:601 HWY 110 N
Practice Address - Street 2:BAY 0
Practice Address - City:WHITEHOUSE
Practice Address - State:TX
Practice Address - Zip Code:75791-3037
Practice Address - Country:US
Practice Address - Phone:903-839-2585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX553840207P00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-0818167-022OtherTRICARE
TX75-2616977-129OtherTRICARE
TX752616977023OtherTRICARE
TX142068907Medicaid
TX75-2616977-028OtherTRICARE
TX8617NPOtherBCBS
TXP01470490OtherRAIL ROAD MEDICARE
TX810N87OtherBCBS
TX75-2616977-002OtherTRICARE
TX75-0818167-022OtherTRICARE
TX406777YNSXMedicare PIN
TX8L5884Medicare PIN
TX142068907Medicaid