Provider Demographics
NPI:1548537400
Name:BROWN, KYLE (FNP-C PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:FNP-C PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5966 THISTLE RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80504-6562
Mailing Address - Country:US
Mailing Address - Phone:970-408-9017
Mailing Address - Fax:877-471-6899
Practice Address - Street 1:5966 THISTLE RIDGE AVE
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504-6562
Practice Address - Country:US
Practice Address - Phone:970-408-9017
Practice Address - Fax:877-471-6899
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0993969363LP0808X
CO190200163WC1500X
COAPN.0993969-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO70980080Medicaid