Provider Demographics
NPI:1508235557
Name:BROWN, DENVER
Entity Type:Individual
Prefix:
First Name:DENVER
Middle Name:
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 1:1440 STATE HIGHWAY 248
Mailing Address - Street 2:SUITE J
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-9655
Mailing Address - Country:US
Mailing Address - Phone:417-239-0706
Mailing Address - Fax:417-239-0768
Practice Address - Street 1:1440 STATE HIGHWAY 248
Practice Address - Street 2:SUITE J
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-9655
Practice Address - Country:US
Practice Address - Phone:417-239-0706
Practice Address - Fax:417-239-0768
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOF0915614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily