Provider Demographics
NPI:1063914752
Name:BROWN, TIFFANY LAKESHA
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:LAKESHA
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:LAKESHA
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4578 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63120-2238
Mailing Address - Country:US
Mailing Address - Phone:314-322-2813
Mailing Address - Fax:314-328-8662
Practice Address - Street 1:4578 EMERSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63120-2238
Practice Address - Country:US
Practice Address - Phone:314-322-2813
Practice Address - Fax:314-328-8662
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health