Provider Demographics
NPI:1376500173
Name:BROWN, KELLY LEE (CRNA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:1321 LADY ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-296-2548
Mailing Address - Fax:803-296-2525
Practice Address - Street 1:805 PAMPLICO HWY
Practice Address - Street 2:CAROLINAS HOSPITAL SYSTEM
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6047
Practice Address - Country:US
Practice Address - Phone:843-674-5000
Practice Address - Fax:843-674-2519
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC659367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0557Medicaid
SCAN0557Medicaid
SCAN0557Medicaid