Provider Demographics
NPI:1700035342
Name:BROWN, STEPHANIE ALFORTISH (ANP-BC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ALFORTISH
Last Name:BROWN
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 GASTON AVE
Mailing Address - Street 2:SUITE 100 WEST TOWER
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3922
Mailing Address - Country:US
Mailing Address - Phone:214-827-3610
Mailing Address - Fax:214-279-0390
Practice Address - Street 1:6301 GASTON AVE
Practice Address - Street 2:SUITE 100 WEST TOWER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-3922
Practice Address - Country:US
Practice Address - Phone:214-827-3610
Practice Address - Fax:214-279-0390
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX730501363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health