Provider Demographics
NPI:1245216449
Name:BROWN, PENNY L (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials: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:PO BOX 309
Mailing Address - Street 2:114 HOLLOWELL ROAD
Mailing Address - City:AULANDER
Mailing Address - State:NC
Mailing Address - Zip Code:27805-0309
Mailing Address - Country:US
Mailing Address - Phone:252-345-3791
Mailing Address - Fax:252-345-0480
Practice Address - Street 1:114 HOLLOWELL ROAD
Practice Address - Street 2:
Practice Address - City:AULANDER
Practice Address - State:NC
Practice Address - Zip Code:27805-0309
Practice Address - Country:US
Practice Address - Phone:252-345-3791
Practice Address - Fax:252-345-0480
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000201964363L00000X
NC201964363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2592320Medicare ID - Type UnspecifiedINDIVIDUAL #
NCG96875Medicare UPIN