Provider Demographics
NPI:1124291182
Name:BROWN, MELODY KIM (RN)
Entity type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:KIM
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MELODY
Other - Middle Name:KIM
Other - Last Name:GORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:29605 BARNES AVE
Mailing Address - Street 2:
Mailing Address - City:FT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5650
Mailing Address - Country:US
Mailing Address - Phone:706-787-6756
Mailing Address - Fax:706-787-7458
Practice Address - Street 1:29605 BARNES AVE
Practice Address - Street 2:
Practice Address - City:FT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-787-6756
Practice Address - Fax:706-787-7458
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN136997163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health