Provider Demographics
NPI:1407557432
Name:GENTRY-BROWN, AUDREY (CLC)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:GENTRY-BROWN
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:GENTRY-BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CBE
Mailing Address - Street 1:20409 TRAILS END TER
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-7005
Mailing Address - Country:US
Mailing Address - Phone:571-271-1529
Mailing Address - Fax:
Practice Address - Street 1:20409 TRAILS END TER
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-7005
Practice Address - Country:US
Practice Address - Phone:571-271-1529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN