Provider Demographics
NPI:1205015633
Name:BROWN, JAMIE M (PA-C)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:M
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1711 GOLD DR S
Mailing Address - Street 2:SUITE 170
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103
Mailing Address - Country:US
Mailing Address - Phone:701-232-7705
Mailing Address - Fax:701-893-9046
Practice Address - Street 1:1711 GOLD DR S
Practice Address - Street 2:SUITE 170
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6416
Practice Address - Country:US
Practice Address - Phone:701-232-7705
Practice Address - Fax:701-893-9046
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0375363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN968415100Medicaid
NDN712986Medicare PIN