Provider Demographics
NPI:1679234868
Name:BROWN, KELLY (RDN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 HOOKSETT RD
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-1815
Mailing Address - Country:US
Mailing Address - Phone:603-314-8900
Mailing Address - Fax:
Practice Address - Street 1:1328 HOOKSETT RD
Practice Address - Street 2:
Practice Address - City:HOOKSETT
Practice Address - State:NH
Practice Address - Zip Code:03106-1815
Practice Address - Country:US
Practice Address - Phone:603-314-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1162133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered