Provider Demographics
NPI:1568859536
Name:BROWN, VALARIE J (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:VALARIE
Middle Name:J
Last Name:BROWN
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5847 CANTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-3433
Mailing Address - Country:US
Mailing Address - Phone:601-810-1392
Mailing Address - Fax:
Practice Address - Street 1:105 W RIDGELAND AVE
Practice Address - Street 2:STE 4
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2026
Practice Address - Country:US
Practice Address - Phone:601-810-1392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00-613591744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management