Provider Demographics
NPI:1750717138
Name:BROOKS, KELLY ROBINSON (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ROBINSON
Last Name:BROOKS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5067 COLERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-2417
Mailing Address - Country:US
Mailing Address - Phone:540-604-6155
Mailing Address - Fax:
Practice Address - Street 1:2141 K ST NW
Practice Address - Street 2:SUITE 3
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1810
Practice Address - Country:US
Practice Address - Phone:202-293-5182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001168732163WL0100X
VA10623337163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant