Provider Demographics
NPI:1841507894
Name:ADDISON-BROWN, KRISTIN J (PHD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:J
Last Name:ADDISON-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:PO BOX 16374
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-6706
Mailing Address - Country:US
Mailing Address - Phone:870-203-6085
Mailing Address - Fax:844-270-3469
Practice Address - Street 1:304 SOUTHWEST SQ
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5984
Practice Address - Country:US
Practice Address - Phone:870-203-6065
Practice Address - Fax:870-931-4790
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1573103G00000X, 103TC0700X
AR11-05P103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical