Individual
JOHNNY BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.N.
Contact information
Practice address
317 W RACE ST, ROLLING FORK, MS 39159-2623
(662) 873-6228
(662) 873-2244
Mailing address
317 W RACE ST, ROLLING FORK, MS 39159-2623
(662) 873-6228
(662) 873-2244
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
P121479
MS
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018205
—
MS
Enumeration date
02/04/2008
Last updated
02/12/2008
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