Provider Demographics
NPI:1427299692
Name:BROWN, KAMEKA (PHD)
Entity type:Individual
Prefix:DR
First Name:KAMEKA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 W TAYLOR ST # 1865
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4623
Mailing Address - Country:US
Mailing Address - Phone:773-299-1515
Mailing Address - Fax:347-587-8363
Practice Address - Street 1:433 WEST HARRISON ST
Practice Address - Street 2:SUITE 803103
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60680
Practice Address - Country:US
Practice Address - Phone:773-299-1515
Practice Address - Fax:347-587-8363
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60191808363LF0000X
IL277001242363LF0000X, 363LP0808X, 363LP0808X
IL209007506363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209007506Medicaid