Basic Information
Provider Information
NPI: 1528597705
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROWN
FirstName: KAREN
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: C.N.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: MAPLES
OtherFirstName: KAREN
OtherMiddleName: ANN
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 6350 W ANDREW JOHNSON HWY DEPT 100
Address2:  
City: TALBOTT
State: TN
PostalCode: 378778605
CountryCode: US
TelephoneNumber: 8003553565
FaxNumber: 4237142355
Practice Location
Address1: 10731 CHAPMAN HWY
Address2:  
City: SEYMOUR
State: TN
PostalCode: 378654765
CountryCode: US
TelephoneNumber: 8655730698
FaxNumber: 8655733174
Other Information
ProviderEnumerationDate: 06/09/2017
LastUpdateDate: 06/09/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
376K00000X173239TNY Nursing Service Related ProvidersNurse's Aide 

No ID Information.


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