Provider Demographics
NPI:1093199960
Name:BROWN, KELLYE
Entity Type:Individual
Prefix:
First Name:KELLYE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 SE 12TH ST
Mailing Address - Street 2:UNIT 1072
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-3886
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3004 SE 12TH ST
Practice Address - Street 2:UNIT 1072
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-3886
Practice Address - Country:US
Practice Address - Phone:425-628-3226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula