Provider Demographics
NPI:1205926417
Name:BROWN, KIRK W (PHD, LAT, ATC)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:W
Last Name:BROWN
Suffix:
Gender:M
Credentials:PHD, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3201
Mailing Address - Country:US
Mailing Address - Phone:910-962-7184
Mailing Address - Fax:910-962-7073
Practice Address - Street 1:601 S COLLEGE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3201
Practice Address - Country:US
Practice Address - Phone:910-962-7184
Practice Address - Fax:910-962-7073
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer