Provider Demographics
NPI:1194414557
Name:BROWN, KELLIE (RN)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1915
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76098-1915
Mailing Address - Country:US
Mailing Address - Phone:903-815-3160
Mailing Address - Fax:
Practice Address - Street 1:4400 STATE HIGHWAY 121
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-4561
Practice Address - Country:US
Practice Address - Phone:469-834-6638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX679932163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse