Provider Demographics
NPI:1275995912
Name:BROWN, DEANN MARIE (PA-C, CAQ-PSYCH)
Entity Type:Individual
Prefix:
First Name:DEANN
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C, CAQ-PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 FERRY ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KY
Mailing Address - Zip Code:41169-1371
Mailing Address - Country:US
Mailing Address - Phone:606-388-2898
Mailing Address - Fax:606-388-2901
Practice Address - Street 1:933 29TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-3021
Practice Address - Country:US
Practice Address - Phone:606-325-7500
Practice Address - Fax:606-326-9136
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC470363A00000X
KYPA2086363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant