Provider Demographics
NPI:1497835722
Name:BROWN, GWENDOLYN CLARK (FNP)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:CLARK
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:729-978-0009
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:10425 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2208
Practice Address - Country:US
Practice Address - Phone:214-361-2025
Practice Address - Fax:214-361-2028
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP112485363LF0000X, 363L00000X
TX567461367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165647203Medicaid
TXP00125344OtherRAILROAD
TX8N4436OtherBCBS
TX165647201Medicaid
TX165647203Medicaid
TX165647201Medicaid
TX8A9860Medicare PIN