Provider Demographics
NPI:1477751402
Name:BROWN, DARREL LEE (CFA PA)
Entity Type:Individual
Prefix:MS
First Name:DARREL
Middle Name:LEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:CFA PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 AUDUBON DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471
Mailing Address - Country:US
Mailing Address - Phone:985-845-1501
Mailing Address - Fax:985-845-1601
Practice Address - Street 1:230 AUDUBON DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471
Practice Address - Country:US
Practice Address - Phone:985-845-1501
Practice Address - Fax:985-845-1601
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA075250363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
075250OtherNATL FIRST ASSISTING CORP