Provider Demographics
NPI:1790003044
Name:BROWN, SHARI R (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:R
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 CHESTNUT DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-7462
Mailing Address - Country:US
Mailing Address - Phone:601-992-3274
Mailing Address - Fax:
Practice Address - Street 1:2860 MCDOWELL ROAD EXT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-4238
Practice Address - Country:US
Practice Address - Phone:601-372-1117
Practice Address - Fax:601-373-3004
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR860780363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily