Provider Demographics
NPI:1013590645
Name:BROWN, JONNITA (PA, AT, EMT)
Entity Type:Individual
Prefix:MS
First Name:JONNITA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA, AT, EMT
Other - Prefix:MS
Other - First Name:JONNITA
Other - Middle Name:L
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MT, SN, BLS & AT
Mailing Address - Street 1:9540 GARLAND RD STE 381 #254
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218
Mailing Address - Country:US
Mailing Address - Phone:214-524-4804
Mailing Address - Fax:214-853-4382
Practice Address - Street 1:325 N SAINT PAUL ST STE 3100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201
Practice Address - Country:US
Practice Address - Phone:214-524-4804
Practice Address - Fax:214-853-4382
Is Sole Proprietor?:No
Enumeration Date:2021-05-02
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YP1600X, 133NN1002X, 133VN1201X, 171400000X, 171M00000X, 172A00000X, 172V00000X, 2255A2300X, 363A00000X, 372600000X, 376K00000X, 363A00000X
171W00000X, 390200000X
TX0000000390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractor
No172A00000XOther Service ProvidersDriver
No172V00000XOther Service ProvidersCommunity Health Worker
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No372600000XNursing Service Related ProvidersAdult Companion
No376K00000XNursing Service Related ProvidersNurse's Aide
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1013590645Medicaid