Provider Demographics
NPI:1326751355
Name:BROWN, KAMILLE DENISE
Entity Type:Individual
Prefix:
First Name:KAMILLE
Middle Name:DENISE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 MCEWEN RD APT 4105
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75244-5436
Mailing Address - Country:US
Mailing Address - Phone:469-697-2393
Mailing Address - Fax:
Practice Address - Street 1:4050 MCEWEN RD APT 4105
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75244-5436
Practice Address - Country:US
Practice Address - Phone:469-697-2393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
347C00000X
TXHVF8120347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX37308298OtherDRIVERS LICENSE