Provider Demographics
NPI:1467672550
Name:BROWN, KELLY JO (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JO
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:JO
Other - Last Name:PENNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:44970 COUNTY RD 3
Mailing Address - Street 2:
Mailing Address - City:WINDOM
Mailing Address - State:MN
Mailing Address - Zip Code:56101
Mailing Address - Country:US
Mailing Address - Phone:507-831-4878
Mailing Address - Fax:
Practice Address - Street 1:106 NORTH 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1034
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL0631987164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse