Provider Demographics
NPI:1497432017
Name:BROWN, KEVIN A
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:A
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 VENDOME DR S
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1429
Mailing Address - Country:US
Mailing Address - Phone:614-377-3462
Mailing Address - Fax:
Practice Address - Street 1:2103 BELCHER DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-1504
Practice Address - Country:US
Practice Address - Phone:614-377-3462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility