Basic Information
| Provider Information | |||||||||
| NPI: | 1912097726 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SCOTT D. BROWN | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | FAMILY HEALTH CENTER OF ASHLAND CITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 342 FREY ST | ||||||||
| Address2: | |||||||||
| City: | ASHLAND CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370151734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157921199 | ||||||||
| FaxNumber: | 6157929331 | ||||||||
| Practice Location | |||||||||
| Address1: | 342 FREY ST | ||||||||
| Address2: | |||||||||
| City: | ASHLAND CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370151734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157921199 | ||||||||
| FaxNumber: | 6157929331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 11/26/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | KATHRYN | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6157921199 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 8049 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | APN14199 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | APN12526 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363A00000X | PA1735 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207Q00000X | MD28452 | TN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3370759 | 05 | TN | MEDICAID | 3156863 | 01 | TN | BLUE CROSS BLUE SHIELD OF | OTHER | 44D0914322 | 01 | CLIA | OTHER |