Individual
JERRELL RUSS BROWN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LVN
Contact information
Practice address
1101 S MAIN ST, FT WORTH, TX 76104-4802
(817) 321-4900
Mailing address
PO BOX 397, EDGEWOOD, TX 75117-0397
(682) 433-1050
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
135078
TX
Other
Enumeration date
12/21/2010
Last updated
12/21/2010
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