Provider Demographics
NPI:1265106538
Name:BROWN, DUSTIN GARY (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:GARY
Last Name:BROWN
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W CARTWRIGHT RD APT 825
Mailing Address - Street 2:
Mailing Address - City:BALCH SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75180-4844
Mailing Address - Country:US
Mailing Address - Phone:469-243-0035
Mailing Address - Fax:
Practice Address - Street 1:2300 13TH ST APT A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2182
Practice Address - Country:US
Practice Address - Phone:706-243-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP000747363L00000X
TX1048979363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily