Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 110463 | WV |
N | 363LP2300X | Nurse Practitioner - Primary Care | 110463 | WV |
NPI | 1053088690 |
---|---|
Provider Name | Royale Brown |
First Address | Huntington, WV 25701-3325 |
Second Address | Barboursville, WV 25504-1321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2021 |
Last Update Date | 08/12/2021 |