Provider Demographics
NPI:1407226327
Name:BROWN, CONNIE (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 STEPHANIE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-5418
Mailing Address - Country:US
Mailing Address - Phone:501-475-8866
Mailing Address - Fax:
Practice Address - Street 1:2504 STEPHANIE DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-5418
Practice Address - Country:US
Practice Address - Phone:501-475-8866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137171363LP0808X
ARA004529363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR551791YJSVMedicare PIN