Provider Demographics
NPI:1659510295
Name:KELLY-BROWN, RACHEL G
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:G
Last Name:KELLY-BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 SUNNYSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-6181
Mailing Address - Country:US
Mailing Address - Phone:919-870-8296
Mailing Address - Fax:
Practice Address - Street 1:2804 SUNNYSTONE WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-6181
Practice Address - Country:US
Practice Address - Phone:919-870-8296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174753163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse