Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 211181 | LA |
N | 363L00000X | Nurse Practitioner | 832418 | NV |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 832418 | NV |
NPI | 1003435090 |
---|---|
Provider Name | Mr. Kenneth Joseph Brown |
First Address | Reno, NV 89502-1576 |
Second Address | Reno, NV 89502-1198 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2020 |
Last Update Date | 27/01/2021 |