Provider Demographics
NPI:1427455476
Name:BROWN, KELLY ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:BALEM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:10 TAPPAN LANDING RD APT 53A
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-4840
Mailing Address - Country:US
Mailing Address - Phone:914-262-8740
Mailing Address - Fax:
Practice Address - Street 1:10 TAPPAN LANDING RD APT 53A
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-4840
Practice Address - Country:US
Practice Address - Phone:914-262-8740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY584809-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse