Provider Demographics
NPI:1912331893
Name:BRAZZLE, KELLY N (NP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:N
Last Name:BRAZZLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2316 E MEYER BLVD
Mailing Address - Street 2:1 CANCER WEST
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-1136
Mailing Address - Country:US
Mailing Address - Phone:816-276-4700
Mailing Address - Fax:816-276-3810
Practice Address - Street 1:2316 E MEYER BLVD
Practice Address - Street 2:1 CANCER WEST
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1136
Practice Address - Country:US
Practice Address - Phone:816-276-4700
Practice Address - Fax:816-276-3810
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS75914363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner