Provider Demographics
NPI:1033094545
Name:BROWN, JEDSIA OMEGA
Entity type:Individual
Prefix:
First Name:JEDSIA
Middle Name:OMEGA
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 STURBRIDGE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-2129
Mailing Address - Country:US
Mailing Address - Phone:314-683-0094
Mailing Address - Fax:
Practice Address - Street 1:209 W POINTE DR STE D
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-8310
Practice Address - Country:US
Practice Address - Phone:618-641-3588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025032879363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health