Provider Demographics
NPI:1093399651
Name:BRAGGS, KELCY SEMONE
Entity Type:Individual
Prefix:
First Name:KELCY
Middle Name:SEMONE
Last Name:BRAGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIVINE
Other - Middle Name:ANGELS
Other - Last Name:SENIOR CARE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3223 SPRING HILL AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-1809
Mailing Address - Country:US
Mailing Address - Phone:251-348-1697
Mailing Address - Fax:
Practice Address - Street 1:3223 SPRING HILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-1809
Practice Address - Country:US
Practice Address - Phone:251-348-1697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide