Provider Demographics
NPI:1639376296
Name:BRAUER, KELLY SHAWN (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:SHAWN
Last Name:BRAUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 631767
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1767
Mailing Address - Country:US
Mailing Address - Phone:812-450-6815
Mailing Address - Fax:812-450-6822
Practice Address - Street 1:2851 NEW HARTFORD RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1320
Practice Address - Country:US
Practice Address - Phone:270-228-2811
Practice Address - Fax:270-228-2812
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2023-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY41114207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1844703Medicare PIN