Provider Demographics
NPI:1588236913
Name:BROWN, CHANDRY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHANDRY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 CHADWICK DR SUITE 256
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204
Mailing Address - Country:US
Mailing Address - Phone:601-376-1394
Mailing Address - Fax:
Practice Address - Street 1:1860 CHADWICK DR SUITE 256
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204
Practice Address - Country:US
Practice Address - Phone:601-376-1394
Practice Address - Fax:601-376-2005
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904251363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner