Provider Demographics
NPI: | 1790762078 |
---|---|
Name: | BROWN, ALYCIA (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ALYCIA |
Middle Name: | |
Last Name: | BROWN |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 1987 |
Mailing Address - Street 2: | |
Mailing Address - City: | BOONE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28607-1987 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 828-202-9765 |
Mailing Address - Fax: | 828-579-2764 |
Practice Address - Street 1: | 1760 NC HWY 105 |
Practice Address - Street 2: | |
Practice Address - City: | BOONE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28607-2860 |
Practice Address - Country: | US |
Practice Address - Phone: | 828-202-9765 |
Practice Address - Fax: | 877-847-0561 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2005-12-28 |
Last Update Date: | 2023-12-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 200101428 | 2084P0800X, 2084P0804X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 140C1 | Other | BCBS PROVIDER ID |
H76014 | Medicare UPIN | ||
NC | 2009058A | Medicare PIN |