Provider Demographics
NPI:1740862234
Name:BROWN, DUSTIN KEVIN (PARAMEDIC)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:KEVIN
Last Name:BROWN
Suffix:
Gender:M
Credentials:PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 FOX DEN CT
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-5408
Mailing Address - Country:US
Mailing Address - Phone:864-237-3315
Mailing Address - Fax:
Practice Address - Street 1:402 FOX DEN CT
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-5408
Practice Address - Country:US
Practice Address - Phone:864-237-3315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC010927146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Multi-Specialty