Individual
MICHELLE BROWN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
30 YORKSHIRE PKWY, GULFPORT, MS 39503-4018
(228) 563-3501
(228) 206-6444
Mailing address
30 YORKSHIRE PKWY, GULFPORT, MS 39503-4018
(228) 563-3501
(228) 206-6444
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
DOM05768
MS
252Y00000X
Early Intervention Provider Agency
DOM05768
MS
253Z00000X
In Home Supportive Care Agency
DOM05768
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DOM05768
THE DIVISION OF MEDICAID AND THE ARC OF MISSISSIPPI/CERTIFICATION
MS
Enumeration date
05/01/2015
Last updated
09/12/2016
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