Provider Demographics
NPI:1073070421
Name:DEBROSSE, KELLY K (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:K
Last Name:DEBROSSE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:915 MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-2401
Mailing Address - Country:US
Mailing Address - Phone:937-497-5665
Mailing Address - Fax:937-497-5674
Practice Address - Street 1:915 MICHIGAN ST STE 201
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2401
Practice Address - Country:US
Practice Address - Phone:937-498-5373
Practice Address - Fax:937-498-5377
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024319363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health