Basic Information
| Provider Information | |||||||||
| NPI: | 1003834292 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | JERI | ||||||||
| MiddleName: | SWAIM | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SWAIM | ||||||||
| OtherFirstName: | JERI | ||||||||
| OtherMiddleName: | LYNN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | FNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 846098 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752846098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033246450 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 601 HWY 110 N | ||||||||
| Address2: | BAY 0 | ||||||||
| City: | WHITEHOUSE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757913037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038392585 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 11/15/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 553840 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 363LF0000X | 553840 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 75-0818167-022 | 01 | TX | TRICARE | OTHER | 75-2616977-129 | 01 | TX | TRICARE | OTHER | 752616977023 | 01 | TX | TRICARE | OTHER | 142068907 | 05 | TX | MEDICAID | 75-2616977-028 | 01 | TX | TRICARE | OTHER | 8617NP | 01 | TX | BCBS | OTHER | P01470490 | 01 | TX | RAIL ROAD MEDICARE | OTHER | 810N87 | 01 | TX | BCBS | OTHER | 75-2616977-002 | 01 | TX | TRICARE | OTHER |