Provider Demographics
NPI:1104664168
Name:BROWN, KALLIE KAY (DOULA)
Entity type:Individual
Prefix:MRS
First Name:KALLIE
Middle Name:KAY
Last Name:BROWN
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3665 W 4650 S
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-8816
Mailing Address - Country:US
Mailing Address - Phone:435-994-8660
Mailing Address - Fax:
Practice Address - Street 1:3665 W 4650 S
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-8816
Practice Address - Country:US
Practice Address - Phone:435-994-8660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14074515-0151374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula