Healthcare Provider Details

I. General information

NPI: 1306618640
Provider Name (Legal Business Name): KEYONNA BROWN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4239 PACKARD RD
TOLEDO OH
43612-1939
US

IV. Provider business mailing address

808 LODGE AVE
TOLEDO OH
43609-3028
US

V. Phone/Fax

Practice location:
  • Phone: 419-378-1169
  • Fax:
Mailing address:
  • Phone: 419-378-1169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number516925
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License Number516925
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number516925
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: