Basic Information
| Provider Information | |||||||||
| NPI: | 1891876900 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DNP, APRN-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2609 GLENN HENDREN DR | ||||||||
| Address2: | |||||||||
| City: | LIBERTY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640683313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164074555 | ||||||||
| FaxNumber: | 8167816973 | ||||||||
| Practice Location | |||||||||
| Address1: | 2609 GLENN HENDREN DR | ||||||||
| Address2: | |||||||||
| City: | LIBERTY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640683313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164074555 | ||||||||
| FaxNumber: | 8167816973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 110740 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 208978700 | 05 | MO | MEDICAID | 100382040A | 05 | KS | MEDICAID | 424867026 | 05 | MO | MEDICAID | 28822115 | 01 | MO | BCBS | OTHER | 500016181 | 01 | MO | RR MEDICARE | OTHER |