Provider Demographics
NPI:1427396589
Name:BROWN, WILLIAM J (RN)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:BROWN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:CARRIERE
Mailing Address - State:MS
Mailing Address - Zip Code:39426-7012
Mailing Address - Country:US
Mailing Address - Phone:228-324-5655
Mailing Address - Fax:800-388-8519
Practice Address - Street 1:305 W MOODY ST
Practice Address - Street 2:
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470-7338
Practice Address - Country:US
Practice Address - Phone:601-795-4543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR892473163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse