Provider Demographics
NPI:1295825107
Name:BROWN, WALTER ERIC (APRN, CRNA, NSPM-C)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:ERIC
Last Name:BROWN
Suffix:
Gender:M
Credentials:APRN, CRNA, NSPM-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2763
Mailing Address - Country:US
Mailing Address - Phone:270-982-0826
Mailing Address - Fax:833-471-5852
Practice Address - Street 1:1118 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2763
Practice Address - Country:US
Practice Address - Phone:270-982-0825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1109132367500000X
IAD151650207LP2900X
IN28186878A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine