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General NPI Number Information
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NPI Number | 1982188470
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Entity Type | Individual
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Provider Name | KELLY BROOKE WARREN
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Gender | Female
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Dates
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Enumeration Date | 09/20/2018
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 2215 VETERANS BLVD
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City | METAIRIE
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State | LA
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Zip | 70002
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Country | US
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Telephone | 504-838-3524
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Fax |
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Provider Business Mailing Address
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Address Line | 804 FOUCHER ST
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City | NEW ORLEANS
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State | LA
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Zip | 70115-2518
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Country | US
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Telephone | 561-346-9701
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Fax |
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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 | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 200383
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License Number State | LA
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