Individual
MIKKI S BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
135 W RAVINE RD, STE 5-B, KINGSPORT, TN 37660-3847
(423) 224-3460
(423) 224-3465
Mailing address
PO BOX 1308, KINGSPORT, TN 37662-1308
(423) 224-3460
(423) 224-3465
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
9533
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00013859
NHC CARE ADMINISTRATORS
—
05
—
0221910000
—
WV
01
—
261963
ANTHEM BCBS
—
01
—
3046113
BLUE SHIELD OF TN
—
05
—
3607743
—
TN
05
—
74346818
—
KY
01
—
TN0100
JOHN DEERE
—
Enumeration date
09/07/2005
Last updated
07/08/2007
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