Provider Demographics
NPI:1174895833
Name:BROWN, KACIE M
Entity type:Individual
Prefix:
First Name:KACIE
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 KORINA AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS AFB
Mailing Address - State:ND
Mailing Address - Zip Code:58204-1378
Mailing Address - Country:US
Mailing Address - Phone:614-499-7950
Mailing Address - Fax:
Practice Address - Street 1:1113 KORINA AVE UNIT A
Practice Address - Street 2:
Practice Address - City:GRAND FORKS AFB
Practice Address - State:ND
Practice Address - Zip Code:58204-1378
Practice Address - Country:US
Practice Address - Phone:614-499-7950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant