Provider Demographics
NPI:1245851609
Name:BROWN, AMY NICHELLE
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:NICHELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9249 W MURPHY ST LOT 99
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-2473
Mailing Address - Country:US
Mailing Address - Phone:405-915-9722
Mailing Address - Fax:
Practice Address - Street 1:9249 W MURPHY ST LOT 99
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-2473
Practice Address - Country:US
Practice Address - Phone:405-915-9722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK126706163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse