Provider Demographics
NPI:1992157002
Name:BROWN, MARKITTA A (APRN, FNP-DNP, PMHNP)
Entity type:Individual
Prefix:
First Name:MARKITTA
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:APRN, FNP-DNP, PMHNP
Other - Prefix:
Other - First Name:MARKITTA
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, DNP, PMHNP
Mailing Address - Street 1:53 OLD SALEM RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-6722
Mailing Address - Country:US
Mailing Address - Phone:606-682-2439
Mailing Address - Fax:
Practice Address - Street 1:60 BENNETT CIR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2842
Practice Address - Country:US
Practice Address - Phone:606-682-2439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2023-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2021029170363LP0808X
KY3010485363LP2300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100433400Medicaid