Provider Demographics
NPI:1891851937
Name:BROWN-CONNER, HEATHER KAY (OD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:KAY
Last Name:BROWN-CONNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 R O BROWN RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:KY
Mailing Address - Zip Code:42602-5456
Mailing Address - Country:US
Mailing Address - Phone:606-688-2076
Mailing Address - Fax:
Practice Address - Street 1:999 GUARDIAN WAY
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1722
Practice Address - Country:US
Practice Address - Phone:931-650-4100
Practice Address - Fax:931-650-4101
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2538152W00000X
KY1692DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ0182416Medicaid
TN4090431OtherBCBS
TNQ0182416Medicaid