Provider Demographics
NPI:1548703051
Name:BROWN, KATHLEEN JO (RN)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:JO
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:JO
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:340 BOULEVARD DEL REY DAVID
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-9651
Mailing Address - Country:US
Mailing Address - Phone:520-377-2646
Mailing Address - Fax:520-377-2646
Practice Address - Street 1:340 BOULEVARD DEL REY DAVID
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-9651
Practice Address - Country:US
Practice Address - Phone:520-377-2646
Practice Address - Fax:520-377-2646
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN129460163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse