Provider Demographics
NPI:1508294505
Name:BROWN, BRENDA LEE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:MCREYNOLDS
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:46 SERGEANT PRENTISS DR
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4792
Mailing Address - Country:US
Mailing Address - Phone:601-445-2248
Mailing Address - Fax:601-445-3533
Practice Address - Street 1:46 SERGEANT PRENTISS DR
Practice Address - Street 2:SUITE 201A
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4792
Practice Address - Country:US
Practice Address - Phone:601-445-2248
Practice Address - Fax:601-445-3533
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR862378363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS326628YW2VOtherPTAN