Provider Demographics
NPI:1821878521
Name:KIRK L BROWN
Entity Type:Organization
Organization Name:KIRK L BROWN
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN
Authorized Official - Phone:402-770-0497
Mailing Address - Street 1:4830 WILSHIRE BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-3365
Mailing Address - Country:US
Mailing Address - Phone:402-770-0497
Mailing Address - Fax:
Practice Address - Street 1:4830 WILSHIRE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-3365
Practice Address - Country:US
Practice Address - Phone:402-770-0497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health