Provider Demographics
NPI:1710463963
Name:BROWN, BOBBI JANELLE (LMT)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:JANELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 SE BAYBERRY LN STE 102
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-4387
Mailing Address - Country:US
Mailing Address - Phone:913-636-5631
Mailing Address - Fax:
Practice Address - Street 1:664 SE BAYBERRY LN STE 102
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-4387
Practice Address - Country:US
Practice Address - Phone:913-636-5631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014022480261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service