Individual
RICKY R BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
100 MERCY WAY, JOPLIN, MO 64804-4524
(417) 556-3570
(417) 556-6475
Mailing address
100 MERCY WAY, JOPLIN, MO 64804-4524
(417) 556-3570
(417) 556-6475
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
086800
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
919263905
—
MO
01
—
P00434105
RR MEDICARE
—
Enumeration date
11/08/2005
Last updated
03/16/2016
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