Individual provider Active NPI

Jennifer Field Brown, PHM-CNS/ NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Virginia Beach, VA
National Provider Identifier
1063405686
Registry record updated Dec 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
0024168259 Issued in VA
Practice address
1072 Laskin Rd
Suite 104
Virginia Beach, VA 23451-6364
Phone
(757) 648-8605
Fax
(757) 648-1363
NPI assigned
Aug 30, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Clinical Nurse Specialist 364SP0808X 0015000720 VA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 0024168259 VA Primary

Addresses

Primary practice location

1072 Laskin Rd
Suite 104
Virginia Beach, VA 23451-6364

Mailing address

1072 Laskin Rd
Suite 104
Virginia Beach, VA 23451-6364
Phone (757) 648-8605

Other identifiers 3

IdentifierTypeStateIssuer
O87933OtherVAOPTIMA/ SENTARA
005510961MedicaidVA
437209OtherVAANTHEM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090819000654 VA Practitioner - Certified Clinical Nurse Specialist (CNS) 9638223340 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Clinical Nurse Specialist (CNS)
Education
Other, 1998
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Seaside Behavioral HealthGroup PAC ID 6709168776, 6 clinicians

Practice addresses (Care Compare)

1072 Laskin Rd
Suite 104
Virginia Beach, VA 23451-6387
Phone (757) 648-8605

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0024168259VAMDPsychiatric/Mental Health Nurse Practitioner
0015000720VAMDPsychiatric/Mental Health Clinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Seaside Behavioral Health CurrentSince Nov 1, 2016 Accepting new patients

Locations

1072 Laskin Rd
Ste 104
Virginia Beach, VA 23451
Phone (757) 648-8605

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482796800000",
    "number": "1063405686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1072 LASKIN RD",
            "address_2": "SUITE 104",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234516364",
            "telephone_number": "757-648-8605",
            "fax_number": "757-648-1363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1072 LASKIN RD",
            "address_2": "SUITE 104",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234516364",
            "telephone_number": "757-648-8605",
            "fax_number": "757-648-1363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "JENNIFER",
        "middle_name": "FIELD",
        "name_prefix": "Mrs.",
        "credential": "PHM-CNS/ NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-30",
        "last_updated": "2016-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0808X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "VA",
            "license": "0015000720",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VA",
            "license": "0024168259",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMA/ SENTARA",
            "identifier": "O87933",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005510961",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "437209",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

Verify at the official NPI Registry.