Provider Demographics
NPI:1326605841
Name:BROWN, MICA LAUREN (FNP)
Entity Type:Individual
Prefix:
First Name:MICA
Middle Name:LAUREN
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP
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 850
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-0850
Mailing Address - Country:US
Mailing Address - Phone:423-727-6319
Mailing Address - Fax:423-727-4164
Practice Address - Street 1:222 OAK ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:TN
Practice Address - Zip Code:37683-1526
Practice Address - Country:US
Practice Address - Phone:423-727-6319
Practice Address - Fax:423-727-4164
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN171337163W00000X
TN25126363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse