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Individual provider Active NPI

Miriam Louise Brawley, FNP-C

  • Family Nurse Practitioner
  • Salem, MO
National Provider Identifier
1033646187
Registry record updated Jun 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2006007575 Issued in MO
Practice address
1415 W Scenic Rivers Blvd
Salem, MO 65560-2840
Phone
(573) 729-5533
Fax
(573) 202-2466
NPI assigned
May 20, 2017
Last updated
Jun 6, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2017015433 MO
Family Nurse Practitioner 363LF0000X 2006007575 MO Primary

Addresses

Primary practice location

1415 W Scenic Rivers Blvd
Salem, MO 65560-2840

Mailing address

1050 W 10TH St
Attn: Executive Director of Physician Clinics
Rolla, MO 65401
Phone (573) 364-9000

Other practice location 1

1050 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

Other names 1

  • Mirian Louise Stricklan Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170622000659 MO Practitioner - Nurse Practitioner 4183992704 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pcrmc Medical Group IncGroup PAC ID 1557454063, 113 clinicians

Practice addresses (Care Compare)

1050 W 10TH St
Rolla, MO 65401-2905
Phone (573) 364-9000

1415 W Scenic Rivers Blvd
Salem, MO 65560-2840
Phone (573) 729-5533

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2006007575MOMDFamily Nurse Practitioner
2017015433MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pcrmc Medical Group, Inc CurrentSince May 29, 2017 Accepting new patients
Phelps County Regional Medical Center CurrentSince May 29, 2017 Accepting new patients
Phelps County Regional Medical Center CurrentSince Mar 1, 2020 Accepting new patients

Locations

1000 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

1050 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

1415 W Scenic Rivers Blvd
Salem, MO 65560
Phone (573) 729-5533

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1495238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1033646187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 W 10TH ST",
            "address_2": "ATTN: EXECUTIVE DIRECTOR OF PHYSICIAN CLINICS",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "65401",
            "telephone_number": "573-364-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 W SCENIC RIVERS BLVD",
            "city": "SALEM",
            "state": "MO",
            "postal_code": "655602840",
            "telephone_number": "573-729-5533",
            "fax_number": "573-202-2466"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1050 W 10th St",
            "address_purpose": "LOCATION",
            "city": "Rolla",
            "state": "MO",
            "postal_code": "65401",
            "country_code": "US",
            "telephone_number": "573-364-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRAWLEY",
        "first_name": "MIRIAM",
        "middle_name": "LOUISE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-20",
        "last_updated": "2022-06-06",
        "certification_date": "2022-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2017015433",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2006007575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRIAN",
            "last_name": "STRICKLAN",
            "middle_name": "LOUISE",
            "credential": "FNP-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Salem, MO

Sources for this page

Verify at the official NPI Registry.