Jetuwan M Brown, REGISTERED NURSE
Individual provider Active NPI Registered Nurse · Canton, MS
NPI 1104176049 · NPPES record last updated Apr 21, 2022
Key facts
- NPI
- 1104176049
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- R875060 (MS)
- Practice address
- 115 Aulenbrock Dr Ste a
Canton, MS 39046-7061 - Phone
- (601) 278-6710
- NPI assigned
- Sep 18, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R875060 | MS | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Haven | Current |
Accepting new patients | |
| Kids' Kastle Gluckstadt | Current |
Accepting new patients | |
| Quality Healthcare and Hospice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R875060 | MS | Yes |
Addresses
Primary practice location
115 Aulenbrock Dr Ste a
Canton, MS 39046-7061
Mailing address
103 Honours Dr
Madison, MS 39110-6513
Phone (601) 278-6710
Other names
- Jetuwan Y McGruder
Other providers in Canton, MS
- Stacey Blount-Parish
- Rashada Keadria Boler
- Jennifer Boose
- Cassandra Brown
- Jessica Nicole Brown
- Tasha Brown
- Suzanne M Bryant
- Trent Lydell Butler
- Buttah Baby LLC
- Victoria Lynn Campbell
All providers in Canton, MS · Registered Nurse in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.