Provider Demographics
NPI:1114984028
Name:BROWN, KAYDEE E (LD)
Entity Type:Individual
Prefix:
First Name:KAYDEE
Middle Name:E
Last Name:BROWN
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:KAYDEE
Other - Middle Name:E
Other - Last Name:WICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CD
Mailing Address - Street 1:6341 UNIVERSITY AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4946
Mailing Address - Country:US
Mailing Address - Phone:763-586-5844
Mailing Address - Fax:
Practice Address - Street 1:6341 UNIVERSITY AVE NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-4946
Practice Address - Country:US
Practice Address - Phone:763-586-5844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2936133V00000X
WI1807133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered