Provider Demographics
NPI:1053376368
Name:BROWN, ANGELICA S (APRN)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:S
Last Name:BROWN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:1930 BISHOP LN
Practice Address - Street 2:SUITE 1600
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1921
Practice Address - Country:US
Practice Address - Phone:502-272-5044
Practice Address - Fax:502-272-5121
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3002836363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000107337OtherANTHEM - NCMA
008920OtherSIHO - NCMA
KY000000642488OtherANTHEM - HOUSE CALLS
KY2802676OtherCIGNA
2436183000OtherPAD - NCMA
IN200251100Medicaid
50015295OtherPASSPORT - NCMA
KY50027323OtherPASSPORT & PASSPORT ADVANTAGE - HOUSE CALLS
KY7800413200Medicaid
KY50027323OtherPASSPORT & PASSPORT ADVANTAGE - HOUSE CALLS
KYS70462Medicare UPIN
2436183000OtherPAD - NCMA
KY2802676OtherCIGNA