Provider Demographics
NPI:1689953127
Name:BROWN, HEATHER DEEANN (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DEEANN
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 1:240 MEDICAL PARK BLVD STE 2700
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-7352
Mailing Address - Country:US
Mailing Address - Phone:423-844-0501
Mailing Address - Fax:423-844-0006
Practice Address - Street 1:240 MEDICAL PARK BLVD STE 2700
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7352
Practice Address - Country:US
Practice Address - Phone:423-844-0501
Practice Address - Fax:423-844-0006
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1994363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical