Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP134476 | TX |
NPI | 1003329236 |
---|---|
Provider Name | Jessica Anne Brown |
First Address | Austin, TX 78735-6350 |
Second Address | Austin, TX 78745-1116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2017 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AP134476 | TEXAS APRN LICENSE (01) | TX |