Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | TX | |
N | 207PE0004X | Emergency Medical Services | 00000 | TX |
N | 207Q00000X | Family Doctor | 00000 | TX |
N | 225400000X | Rehabilitation Practitioner | TX |
NPI | 1013590645 |
---|---|
Provider Name | Ms. Jonnita Brown |
First Address | Mesquite, TX 75150-4728 |
Second Address | Balch Springs, TX 75180-1260 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2021 |
Last Update Date | 03/06/2021 |