Provider Demographics
NPI:1215353636
Name:BROWN, KRISTIANA L (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTIANA
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTIANA
Other - Middle Name:LOUISE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:10 WOODLAKE TRL STE C
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-9573
Mailing Address - Country:US
Mailing Address - Phone:740-392-7337
Mailing Address - Fax:740-392-7333
Practice Address - Street 1:10 WOODLAKE TRL STE C
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-9573
Practice Address - Country:US
Practice Address - Phone:740-392-7337
Practice Address - Fax:740-392-7333
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003972RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0100008Medicaid