MEDICARE: KELLY BROWN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	236320	NY

General Provider Information

NPI Number	:	1982127312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY BROWN

Provider Business Mailing Address
First Line	:	555 W 174TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-8203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 W 174TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-8203
Country	:	US
Telephone Number	:	646-667-1156
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2017
Last Update Date	:	07/18/2017

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Directions to “ KELLY BROWN ” Practice Location

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