Provider Demographics
NPI:1992506661
Name:BROWN, PHYLLIS J
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:J
Last Name:BROWN
Suffix:
Gender:
Credentials:
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 74
Mailing Address - Street 2:
Mailing Address - City:CULLODEN
Mailing Address - State:WV
Mailing Address - Zip Code:25510-0074
Mailing Address - Country:US
Mailing Address - Phone:681-204-9280
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 74
Practice Address - Street 2:
Practice Address - City:CULLODEN
Practice Address - State:WV
Practice Address - Zip Code:25510-0074
Practice Address - Country:US
Practice Address - Phone:681-204-9280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant