Provider Demographics
NPI:1386326270
Name:BROWN, NICOLE YVETTE (RN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:YVETTE
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16516 E ELLISON WAY
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-2826
Mailing Address - Country:US
Mailing Address - Phone:816-814-2790
Mailing Address - Fax:816-373-1353
Practice Address - Street 1:4801 E LINWOOD BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64128-2226
Practice Address - Country:US
Practice Address - Phone:816-548-0990
Practice Address - Fax:816-922-4838
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO140914163WG0000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice