Provider Demographics
NPI:1720418114
Name:BROWN, NICHOLAS ALLAN
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ALLAN
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 GINGERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-3010
Mailing Address - Country:US
Mailing Address - Phone:502-554-7113
Mailing Address - Fax:
Practice Address - Street 1:200 HIGH RISE DR
Practice Address - Street 2:#330
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-3252
Practice Address - Country:US
Practice Address - Phone:502-589-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator