Provider Demographics
NPI:1801122304
Name:BROWN, AMBER HARDEN (PA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:HARDEN
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:FAYE
Other - Last Name:HARDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1010 E DIXON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-6838
Mailing Address - Country:US
Mailing Address - Phone:980-487-2900
Mailing Address - Fax:980-487-2901
Practice Address - Street 1:1010 E DIXON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-6838
Practice Address - Country:US
Practice Address - Phone:980-487-2900
Practice Address - Fax:980-487-2901
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001002459363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1801122304Medicaid
SC1073PAMedicaid
NC8103076Medicaid
NCNC7658IMedicare PIN
NC1801122304Medicaid
NCNC7658HMedicare PIN
FLCN375ZMedicare UPIN
NC8103076Medicaid
SC1073PAMedicaid
NCNC7658EMedicare PIN
NCNC7658DMedicare PIN
NCNC7658CMedicare PIN