Provider Demographics
NPI:1992422851
Name:BROWN, MINDY ANN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:ANN
Last Name:BROWN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 HEMPSTEAD 173 W
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801-9020
Mailing Address - Country:US
Mailing Address - Phone:903-278-4390
Mailing Address - Fax:
Practice Address - Street 1:224 HEMPSTEAD 173 W
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-9020
Practice Address - Country:US
Practice Address - Phone:903-559-5067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1097086363LG0600X
AR222108363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology