Provider Demographics
NPI:1750683843
Name:BROWN, KIMBERLY CHARION (CNA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CHARION
Last Name:BROWN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:KELVIN
Other - Middle Name:LEE
Other - Last Name:BROWN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:CNA
Mailing Address - Street 1:411 SPEED ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-5170
Mailing Address - Country:US
Mailing Address - Phone:252-562-8072
Mailing Address - Fax:
Practice Address - Street 1:411 SPEED ST.
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NC
Practice Address - Zip Code:27909
Practice Address - Country:US
Practice Address - Phone:252-562-8072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1401107957172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker