Provider Demographics
NPI:1255560686
Name:BROWN, TRAVEN JELANI I
Entity type:Individual
Prefix:MR
First Name:TRAVEN
Middle Name:JELANI
Last Name:BROWN
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S MACARTHUR BLVD
Mailing Address - Street 2:APT 2128
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-6718
Mailing Address - Country:US
Mailing Address - Phone:318-512-5105
Mailing Address - Fax:
Practice Address - Street 1:600 S MACARTHUR BLVD
Practice Address - Street 2:APT 2128
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-6718
Practice Address - Country:US
Practice Address - Phone:318-512-5105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide