Provider Demographics
NPI:1093914632
Name:BROWN, REBECCA A (APRN)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11516 BELLEWOOD GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2464
Mailing Address - Country:US
Mailing Address - Phone:502-639-5858
Mailing Address - Fax:
Practice Address - Street 1:9080 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-1750
Practice Address - Country:US
Practice Address - Phone:502-639-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004782363LF0000X
FLRN9412735363LF0000X
IN71005171A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100074640Medicaid
KYK024024Medicare PIN