Provider Demographics
NPI:1326801358
Name:BROWN MARTINEZ, HARRY NELSON (APRN)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:NELSON
Last Name:BROWN MARTINEZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 YORKTOWN RD APT 4
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-4940
Mailing Address - Country:US
Mailing Address - Phone:502-403-6272
Mailing Address - Fax:
Practice Address - Street 1:7101 YORKTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-4940
Practice Address - Country:US
Practice Address - Phone:502-403-6272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3019134363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty