Jetuwan M Brown, REGISTERED NURSE

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

R875060 Issued in MS

Practice address

115 Aulenbrock Dr Ste a
Canton, MS 39046-7061

Phone

(601) 278-6710

NPI assigned

Sep 18, 2012

Last updated

Apr 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jetuwan Y McGruder Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Kids' Kastle Gluckstadt

  • Pediatric Skilled Nursing Facility
  • Canton, MS
  • NPI 1962041798
  NPD Authorized official
• Pediatric Haven

  dba Pediatric Haven Autism Center

  • Adolescent and Children Mental Health Clinic/Center
  • Pearl, MS
  • NPI 1043858053
  NPD Authorized official
• Quality Healthcare and Hospice

  • Nursing Care Agency
  • Clinton, MS
  • NPI 1588915268
  NPD (past) Authorized official

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

{
    "created_epoch": "1347926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650499200000",
    "number": "1104176049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 HONOURS DR",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106513",
            "telephone_number": "601-278-6710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 AULENBROCK DR STE A",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390467061",
            "telephone_number": "601-278-6710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "JETUWAN",
        "middle_name": "M",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-18",
        "last_updated": "2022-04-21",
        "certification_date": "2022-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MS",
            "license": "R875060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JETUWAN",
            "last_name": "MCGRUDER",
            "middle_name": "Y",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Stacey Blount-Parish, LIFESTYLE COACH
• Rashada Keadria Boler, BSN, RN, CCRN
• Jennifer Boose, NP
• Cassandra Brown, LPC
• Jessica Nicole Brown, NP
• Tasha Brown, LIFESTYLE COACH
• Suzanne M Bryant, C. F. N. P.
• Trent Lydell Butler, PT
• Buttah Baby LLC
• Victoria Lynn Campbell, RDN

• Registered Nurse in Canton, MS
• Providers in Canton, MS by specialty
• Registered Nurse in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.