Provider Demographics
NPI:1174034037
Name:HADNOTT-BROWN, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HADNOTT-BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4517 MONT EAGLE PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-3418
Mailing Address - Country:US
Mailing Address - Phone:323-455-4915
Mailing Address - Fax:
Practice Address - Street 1:4515 MONT EAGLE PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-3418
Practice Address - Country:US
Practice Address - Phone:323-455-4915
Practice Address - Fax:323-255-8484
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide