Provider Demographics
NPI:1891876900
Name:BROWN, PAULA M (DNP, APRN-BC)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:DNP, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 GLENN HENDREN DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3313
Mailing Address - Country:US
Mailing Address - Phone:816-407-4555
Mailing Address - Fax:816-781-6973
Practice Address - Street 1:2609 GLENN HENDREN DR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3313
Practice Address - Country:US
Practice Address - Phone:816-407-4555
Practice Address - Fax:816-781-6973
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110740363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208978700Medicaid
KS100382040AMedicaid
MO424867026Medicaid
MO28822115OtherBCBS
MO500016181OtherRR MEDICARE
MO424867026Medicaid
MO701A657Medicare ID - Type Unspecified