Provider Demographics
NPI:1295297273
Name:BROWN, NIKI L'SHAUN
Entity type:Individual
Prefix:
First Name:NIKI
Middle Name:L'SHAUN
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 1:2712 9TH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-4701
Mailing Address - Country:US
Mailing Address - Phone:806-632-1037
Mailing Address - Fax:
Practice Address - Street 1:2712 9TH AVE APT 4
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-4701
Practice Address - Country:US
Practice Address - Phone:806-632-1037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer