Provider Demographics
NPI:1750547840
Name:BRACCO, KELLY DOCKING
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:DOCKING
Last Name:BRACCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4514 W 72ND ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-2818
Mailing Address - Country:US
Mailing Address - Phone:913-384-3843
Mailing Address - Fax:
Practice Address - Street 1:4514 W 72ND ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-2818
Practice Address - Country:US
Practice Address - Phone:913-384-3843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor