Provider Demographics
NPI:1205206109
Name:BROWN, DAWN (APRN,FNP-C)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:APRN,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 N 14TH ST STE 114
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1807
Mailing Address - Country:US
Mailing Address - Phone:580-762-2366
Mailing Address - Fax:580-765-0899
Practice Address - Street 1:2101 N 14TH ST STE 114
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1807
Practice Address - Country:US
Practice Address - Phone:580-762-2366
Practice Address - Fax:580-765-0899
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK78425364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK51662OtherOBNDD
OK78425OtherAPRN,FNP-C