Healthcare Provider Details

I. General information

NPI: 1568330934
Provider Name (Legal Business Name): BREONNA KERLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 YORK RD STE 214
TIMONIUM MD
21093-2276
US

IV. Provider business mailing address

2800 HIRSCHFIELD RD APT 48
SPRING TX
77373-8810
US

V. Phone/Fax

Practice location:
  • Phone: 443-202-7736
  • Fax:
Mailing address:
  • Phone: 832-420-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116858
License Number StateTX

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: