Provider Demographics
NPI:1477082337
Name:BROWN, BRIAN L (NP)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:BROWN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1511
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93279-1511
Mailing Address - Country:US
Mailing Address - Phone:559-372-7390
Mailing Address - Fax:595-372-7553
Practice Address - Street 1:1827 S COURT ST STE A
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-5469
Practice Address - Country:US
Practice Address - Phone:559-372-7390
Practice Address - Fax:559-372-7553
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95006704363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP95006704OtherSTATE LIC