Provider Demographics
NPI:1336422021
Name:BROWN, ELIZABETH WHITAKER (MSN, RN)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:WHITAKER
Last Name:BROWN
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 W CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-2603
Mailing Address - Country:US
Mailing Address - Phone:601-833-9388
Mailing Address - Fax:601-833-9495
Practice Address - Street 1:1007 W CONGRESS ST
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2603
Practice Address - Country:US
Practice Address - Phone:601-833-9388
Practice Address - Fax:601-833-9495
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR880146363L00000X, 363LA2200X
AL1-120146363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily