Provider Demographics
NPI:1952801169
Name:BROWN, BRIAN KENNETH (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:KENNETH
Last Name:BROWN
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 WILSON DR
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-2814
Mailing Address - Country:US
Mailing Address - Phone:615-478-4704
Mailing Address - Fax:
Practice Address - Street 1:401 WINDSOR GREEN CT STE 101
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2237
Practice Address - Country:US
Practice Address - Phone:615-859-8488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000023815363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily