Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | 7961-M | AR |
Y | 1041C0700X | Clinical Social Worker | 7961-C | AR |
NPI | 1003236340 |
---|---|
Provider Name | Rachel Nicole Brown |
First Address | Jonesboro, AR 72405-7870 |
Second Address | Jacksonville, AR 72076-2868 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2014 |
Last Update Date | 07/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
233985719 | (05) | AR |