Provider Demographics
NPI:1194317321
Name:BROOKS BORRERO, KELLY BRITTANY (MS, RDN, LDN, CNSC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:BRITTANY
Last Name:BROOKS BORRERO
Suffix:
Gender:F
Credentials:MS, RDN, LDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 MCMILLAN ST
Mailing Address - Street 2:
Mailing Address - City:HURLBURT FIELD
Mailing Address - State:FL
Mailing Address - Zip Code:32544-1090
Mailing Address - Country:US
Mailing Address - Phone:803-246-8249
Mailing Address - Fax:
Practice Address - Street 1:1085 MCMILLAN ST
Practice Address - Street 2:
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:32544-1090
Practice Address - Country:US
Practice Address - Phone:803-246-8249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND12503133V00000X
AL3031133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered