Provider Demographics
NPI:1487690558
Name:BROWN, LAURIE JEAN (FNP)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:JEAN
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:JEAN
Other - Last Name:FESSENDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:I-MD, FNP
Mailing Address - Street 1:101 RAINBOW DR
Mailing Address - Street 2:PMB 14381
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77399
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:855-888-0812
Practice Address - Street 1:5600 N MAY AVE STE 310
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4291
Practice Address - Country:US
Practice Address - Phone:888-731-8994
Practice Address - Fax:833-775-1861
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ238701363LF0000X
WY47814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ005064Medicaid
TX8B1703Medicare ID - Type UnspecifiedMEDICARE NUMBER
TX8B1703Medicare UPIN