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General NPI Number Information
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NPI Number | 1528682002
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Entity Type | Individual
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Provider Name | KELLY KILBURN MCBRAYER PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/01/2020
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 165 NATCHEZ TRACE AVE STE 205
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City | BOWLING GREEN
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State | KY
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Zip | 42103-7947
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Country | US
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Telephone | 270-745-7246
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Fax | 270-282-2027
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Provider Business Mailing Address
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Address Line | PO BOX 21890
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City | BELFAST
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State | ME
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Zip | 04915-4115
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Country | US
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Telephone | 502-907-0356
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Fax | 502-919-9780
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4423
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2738
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License Number State | KY
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