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NPI Code Detail

MEDICARE: BROOKE KELLY

MEDICARE: BROOKE KELLY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramLA
2163W00000XRegistered Nurse215601LA

General Provider Information

NPI Number : 1144173782
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE KELLY
Provider Business Mailing Address
First Line : 5220 ESSEN LN
Second Line :
City : BATON ROUGE
State : LA
Zip : 70809-3542
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5220 ESSEN LN
Second Line :
City : BATON ROUGE
State : LA
Zip : 70809-3542
Country : US
Telephone Number : 225-526-1971
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2026
Last Update Date : 02/16/2026

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Directions to “ BROOKE KELLY ” Practice Location

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