=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558818294
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KERI BROWNING LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2016
-----------------------------------------------------
Last Update Date | 09/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 294 SHAWNEE CIR
-----------------------------------------------------
City | MONAVILLE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25601-9631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-928-9879
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 263
-----------------------------------------------------
City | WILKINSON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25653-0263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-928-9879
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 2010-2692
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------