Basic Information
Provider Information | |||||||||
NPI: | 1982738175 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BROWN | ||||||||
FirstName: | MICHELLE | ||||||||
MiddleName: | DENISE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | RNC, WHCNP, PMHNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 600 SUN TEMPLE DR | ||||||||
Address2: |   | ||||||||
City: | MADISON | ||||||||
State: | AL | ||||||||
PostalCode: | 357588643 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2562883333 | ||||||||
FaxNumber: | 2562883334 | ||||||||
Practice Location | |||||||||
Address1: | 600 SUN TEMPLE DR | ||||||||
Address2: |   | ||||||||
City: | MADISON | ||||||||
State: | AL | ||||||||
PostalCode: | 357588643 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2562883333 | ||||||||
FaxNumber: | 2562883334 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/16/2007 | ||||||||
LastUpdateDate: | 04/06/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/06/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WW0101X | RN100598 | LA | N |   | Nursing Service Providers | Registered Nurse | Women's Health Care, Ambulatory | 363LP0808X | AP04840 | LA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
ID | Type | State | Issuer | Description | BRO104318480 | 01 |   | NATIONAL CERTIFICATION CO | OTHER | 630323 | 01 | CA | REGISTERED NURSE | OTHER | R872713 | 01 | MI | REGISTERED NURSE | OTHER |