Provider Demographics
NPI:1689941502
Name:BROWER, KELLY JON (RD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JON
Last Name:BROWER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MANNING DR
Mailing Address - Street 2:DEPARTMENT OUTPATIENT MEDICAL NUTRITION
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4220
Mailing Address - Country:US
Mailing Address - Phone:919-966-0837
Mailing Address - Fax:984-974-1191
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:DEPARTMENT OUTPATIENT MEDICAL NUTRITION
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:919-966-0837
Practice Address - Fax:984-974-1191
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003424133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered