Provider Demographics
NPI:1467850107
Name:BRANNON, KELLY C (LPN)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:C
Last Name:BRANNON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10556 FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-8503
Mailing Address - Country:US
Mailing Address - Phone:440-829-8525
Mailing Address - Fax:
Practice Address - Street 1:10556 FLORIDA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-8503
Practice Address - Country:US
Practice Address - Phone:440-829-8525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH144572164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse