Provider Demographics
NPI:1497483390
Name:BROWN, JENNIFER L (PMH-NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:PMH-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4925 CHARLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9426
Mailing Address - Country:US
Mailing Address - Phone:812-941-9200
Mailing Address - Fax:812-941-9205
Practice Address - Street 1:4925 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9426
Practice Address - Country:US
Practice Address - Phone:812-941-9200
Practice Address - Fax:812-941-9205
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018145363LP0808X
IN71013768A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3018145OtherSTATE LICENSE