Provider Demographics
NPI:1174410229
Name:BROWN, TRAVIS REGINALD II (PMHNP, DNP)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:REGINALD
Last Name:BROWN
Suffix:II
Gender:M
Credentials:PMHNP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 14TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3966
Mailing Address - Country:US
Mailing Address - Phone:818-940-9697
Mailing Address - Fax:
Practice Address - Street 1:385 14TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3966
Practice Address - Country:US
Practice Address - Phone:818-940-9697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2025000002363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health