Provider Demographics
NPI:1689223869
Name:BROWN, AMY ROSEMARIE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ROSEMARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:ROSEMARIE
Other - Last Name:KENNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:4949 NEOSHO ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2954
Mailing Address - Country:US
Mailing Address - Phone:636-795-6895
Mailing Address - Fax:
Practice Address - Street 1:1201 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1016
Practice Address - Country:US
Practice Address - Phone:314-257-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019026965363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily