Provider Demographics
NPI:1487295531
Name:BROWN, MICK ALLEN (FNP)
Entity type:Individual
Prefix:
First Name:MICK
Middle Name:ALLEN
Last Name:BROWN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2636 16TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-2984
Mailing Address - Country:US
Mailing Address - Phone:509-295-1892
Mailing Address - Fax:
Practice Address - Street 1:903 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:RITZVILLE
Practice Address - State:WA
Practice Address - Zip Code:99169-2227
Practice Address - Country:US
Practice Address - Phone:509-659-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61006342363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner