Provider Demographics
NPI:1710217419
Name:KELLEY-BROWN, EMILY JOSEPHINE (MPH, RD, CD, CSP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:JOSEPHINE
Last Name:KELLEY-BROWN
Suffix:
Gender:F
Credentials:MPH, RD, CD, CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18126 76TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-8929
Mailing Address - Country:US
Mailing Address - Phone:425-238-4901
Mailing Address - Fax:
Practice Address - Street 1:18126 76TH AVE NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-8929
Practice Address - Country:US
Practice Address - Phone:425-238-4901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
TXDT89526133V00000X
WADI60065377133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered