Provider Demographics
NPI:1376785014
Name:BROWN, SUZANNE MACHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MACHELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4217 ANTIGUA CT
Mailing Address - Street 2:
Mailing Address - City:ORANGE BEACH
Mailing Address - State:AL
Mailing Address - Zip Code:36561-6500
Mailing Address - Country:US
Mailing Address - Phone:251-981-6246
Mailing Address - Fax:
Practice Address - Street 1:4217 ANTIGUA CT
Practice Address - Street 2:
Practice Address - City:ORANGE BEACH
Practice Address - State:AL
Practice Address - Zip Code:36561-6500
Practice Address - Country:US
Practice Address - Phone:251-981-6246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-636363AM0700X
ALPA.636363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL185009Medicaid
AL1085414OtherNCCPA