Provider Demographics
NPI:1023103637
Name:BROWN, KRISTY L (NURSE PRACTICIONER)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:NURSE PRACTICIONER
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 3007
Mailing Address - Street 2:945 SUNRISE DRIVE
Mailing Address - City:PAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:86040-3007
Mailing Address - Country:US
Mailing Address - Phone:928-608-0994
Mailing Address - Fax:
Practice Address - Street 1:4313 BULLFROG
Practice Address - Street 2:
Practice Address - City:LAKE POWELL
Practice Address - State:UT
Practice Address - Zip Code:84533-4313
Practice Address - Country:US
Practice Address - Phone:435-684-2288
Practice Address - Fax:435-684-2239
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT201303440363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005815305Medicare ID - Type UnspecifiedMEDICARE
AZP00987Medicare UPIN