Provider Demographics
NPI:1659342947
Name:BROWN, CYNTHIA KAY (PA)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:KAY
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4805 E HIGHWAY 37
Mailing Address - Street 2:
Mailing Address - City:TUTTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73089-8723
Mailing Address - Country:US
Mailing Address - Phone:405-381-9979
Mailing Address - Fax:405-381-9130
Practice Address - Street 1:4805 E HIGHWAY 37
Practice Address - Street 2:
Practice Address - City:TUTTLE
Practice Address - State:OK
Practice Address - Zip Code:73089-8723
Practice Address - Country:US
Practice Address - Phone:405-381-9979
Practice Address - Fax:405-381-9130
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK954363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200074840AMedicaid
OK5515260001Medicare NSC
OK200074840AMedicaid
OKQ63884Medicare UPIN