Provider Demographics
NPI:1073582664
Name:BROWN, CHEYENNE K (CNM MLP-NURSE PRACTI)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:K
Last Name:BROWN
Suffix:
Gender:F
Credentials:CNM MLP-NURSE PRACTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4685 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3397
Mailing Address - Country:US
Mailing Address - Phone:513-246-1964
Mailing Address - Fax:
Practice Address - Street 1:10496 MONTGOMERY RD STE 110
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-5220
Practice Address - Country:US
Practice Address - Phone:513-671-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNM08212367A00000X
OHAPRN.CNM.08212367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200800130CMedicaid
OH2571631Medicaid
IN200800130CMedicaid