Provider Demographics
NPI:1508399387
Name:BROWN, KRYSTAL DONAE (CNM)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:DONAE
Last Name:BROWN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 JACKSON ST
Mailing Address - Street 2:APT. 401
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75202-5212
Mailing Address - Country:US
Mailing Address - Phone:214-862-5830
Mailing Address - Fax:
Practice Address - Street 1:6300 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5259
Practice Address - Country:US
Practice Address - Phone:214-266-0130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX798239163WX0002X
TXAP132845367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk