Provider Demographics
NPI:1336571447
Name:BROWN, RICHARD A (NP-C)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:BROWN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 9TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6431
Mailing Address - Country:US
Mailing Address - Phone:575-446-5900
Mailing Address - Fax:575-446-5939
Practice Address - Street 1:2669 SCENIC DR
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8700
Practice Address - Country:US
Practice Address - Phone:575-446-5900
Practice Address - Fax:575-446-5939
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013017928363L00000X
NMCNP-02396363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMCNP-02396OtherNM LICENSE