Provider Demographics
NPI:1760989610
Name:BRIGGS, KELLY LYNN (RN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:BRIGGS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LYNN
Other - Last Name:LAUGESEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1624 HASTINGS DR
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-7013
Mailing Address - Country:US
Mailing Address - Phone:785-217-6944
Mailing Address - Fax:785-217-6944
Practice Address - Street 1:1777 W YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-5187
Practice Address - Country:US
Practice Address - Phone:209-825-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-08
Last Update Date:2018-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA772537163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse