Provider Demographics
NPI:1811954969
Name:BROWN, NYKEDTRA MARTIN (FNP)
Entity type:Individual
Prefix:MRS
First Name:NYKEDTRA
Middle Name:MARTIN
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:212 ASHTON GLN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-9451
Mailing Address - Country:US
Mailing Address - Phone:919-308-4027
Mailing Address - Fax:
Practice Address - Street 1:1002 S EUGENE ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-1308
Practice Address - Country:US
Practice Address - Phone:336-355-9696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC005001451363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ69695Medicare UPIN