Provider Demographics
NPI:1316243140
Name:BROWN, KIRK (LPN)
Entity type:Individual
Prefix:MR
First Name:KIRK
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ALKIER ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4908
Mailing Address - Country:US
Mailing Address - Phone:347-631-2860
Mailing Address - Fax:
Practice Address - Street 1:101 ALKIER ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4908
Practice Address - Country:US
Practice Address - Phone:347-631-2860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302583E164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse