Provider Demographics
NPI:1629145032
Name:BROWN, VALARIE L (PA-C)
Entity Type:Individual
Prefix:
First Name:VALARIE
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:ISABEL
Mailing Address - State:SD
Mailing Address - Zip Code:57633-0097
Mailing Address - Country:US
Mailing Address - Phone:605-466-2120
Mailing Address - Fax:605-466-2190
Practice Address - Street 1:8000 E HWY 212
Practice Address - Street 2:
Practice Address - City:EAGLE BUTTE
Practice Address - State:SD
Practice Address - Zip Code:57625-0860
Practice Address - Country:US
Practice Address - Phone:605-964-8000
Practice Address - Fax:605-964-1118
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0165363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical