Provider Demographics
NPI:1689910929
Name:BROWN, KATHLEEN T (A-NP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:T
Last Name:BROWN
Suffix:
Gender:F
Credentials:A-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:887 OLD COUNTRY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2115
Mailing Address - Country:US
Mailing Address - Phone:631-727-6122
Mailing Address - Fax:631-727-2672
Practice Address - Street 1:887 OLD COUNTRY RD
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2115
Practice Address - Country:US
Practice Address - Phone:631-727-6122
Practice Address - Fax:631-727-2672
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY378806-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health