Provider Demographics
NPI:1053716423
Name:BROWN FAMILY MEDICAL CLINIC, LLC
Entity type:Organization
Organization Name:BROWN FAMILY MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:RENIA
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:601-842-3726
Mailing Address - Street 1:102 BUSINESS PARK DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-6016
Mailing Address - Country:US
Mailing Address - Phone:601-842-3726
Mailing Address - Fax:
Practice Address - Street 1:102 BUSINESS PARK DR
Practice Address - Street 2:SUITE G
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-6016
Practice Address - Country:US
Practice Address - Phone:601-842-3726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR860780363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty