Provider Demographics
NPI:1609420629
Name:DIGGS BROWN, KERA TAHMARA (SOLE PROPRIETOR)
Entity Type:Individual
Prefix:MRS
First Name:KERA
Middle Name:TAHMARA
Last Name:DIGGS BROWN
Suffix:
Gender:F
Credentials:SOLE PROPRIETOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4724 GRASSET AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-4025
Mailing Address - Country:US
Mailing Address - Phone:980-875-8693
Mailing Address - Fax:
Practice Address - Street 1:4724 GRASSET AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-4025
Practice Address - Country:US
Practice Address - Phone:980-875-8693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC5105172V00000X, 385H00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No172V00000XOther Service ProvidersCommunity Health Worker
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3892146OtherDIVERS LICENSE
HC5105OtherBUSINESS LICENSE