Provider Demographics
NPI:1073525697
Name:BROWN, CONNIE L (NP)
Entity Type:Individual
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First Name:CONNIE
Middle Name:L
Last Name:BROWN
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Gender:F
Credentials:NP
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Mailing Address - Street 1:5010 CRENSHAW RD
Mailing Address - Street 2:STE: 130
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3097
Mailing Address - Country:US
Mailing Address - Phone:281-991-2200
Mailing Address - Fax:281-991-7700
Practice Address - Street 1:155 IH-10 NORTH
Practice Address - Street 2:STE: 1
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707
Practice Address - Country:US
Practice Address - Phone:281-991-2200
Practice Address - Fax:281-991-7700
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2016-02-16
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Provider Licenses
StateLicense IDTaxonomies
TX253984363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P08262Medicare UPIN