Provider Demographics
NPI:1548658842
Name:BROWN, JENNIFER (APRN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:MAIZE
Mailing Address - State:KS
Mailing Address - Zip Code:67101-7016
Mailing Address - Country:US
Mailing Address - Phone:316-648-2828
Mailing Address - Fax:
Practice Address - Street 1:3450 N ROCK RD STE 503
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1355
Practice Address - Country:US
Practice Address - Phone:316-312-0002
Practice Address - Fax:316-854-5644
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-76475-012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201107280BMedicaid