Provider Demographics
NPI:1205823465
Name:BROWN, JENNIFER LYNN (MD)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LYNN
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:176 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:RAINELLE
Mailing Address - State:WV
Mailing Address - Zip Code:25962-1064
Mailing Address - Country:US
Mailing Address - Phone:304-438-6188
Mailing Address - Fax:304-438-6819
Practice Address - Street 1:520 BECKLEY CROSSING SHPG CTR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-7110
Practice Address - Country:US
Practice Address - Phone:304-252-6639
Practice Address - Fax:304-252-6681
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2020-09-24
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Provider Licenses
StateLicense IDTaxonomies
WV20718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1812285000Medicaid
VA010281491Medicaid
WVH65278Medicare UPIN
WVCO4087243Medicare PIN
VA010281491Medicaid
WVCO4087243Medicare PIN