Provider Demographics
NPI:1962138198
Name:BROWN, AUDRA MICHELLE
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:MICHELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 KANAWHA AVE
Mailing Address - Street 2:APT 14
Mailing Address - City:SMITHERS
Mailing Address - State:WV
Mailing Address - Zip Code:25156
Mailing Address - Country:US
Mailing Address - Phone:681-208-0518
Mailing Address - Fax:
Practice Address - Street 1:200 KANAWHA AVE
Practice Address - Street 2:APT 14
Practice Address - City:SMITHERS
Practice Address - State:WV
Practice Address - Zip Code:25156
Practice Address - Country:US
Practice Address - Phone:681-208-0518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant