Individual provider Active NPI

Kejaina Renee Brown, LPN

  • Licensed Practical Nurse
  • Buffalo, NY
National Provider Identifier
1013685247
Registry record updated Sep 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
338534 Issued in NY
Practice address
1376 E Delavan Ave Uppr
Buffalo, NY 14215-3980
Phone
(716) 228-5376
NPI assigned
Sep 2, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 338534 NY Primary

Addresses

Primary practice location

1376 E Delavan Ave Uppr
Buffalo, NY 14215-3980

Mailing address

1376 E Delavan Ave Uppr
Buffalo, NY 14215-3980
Phone (716) 228-5376

Other practice location 1

1376 E Delavan Ave Uppr
Buffalo, NY 14215-3980

Other identifiers 1

IdentifierTypeStateIssuer
976965613MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Unknown

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1630540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630540800000",
    "number": "1013685247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1376 E DELAVAN AVE UPPR",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142153980",
            "telephone_number": "716-228-5376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1376 E DELAVAN AVE UPPR",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142153980",
            "telephone_number": "716-228-5376"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1376 E Delavan Ave Uppr",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "NY",
            "postal_code": "142153980",
            "country_code": "US",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROWN",
        "first_name": "KEJAINA",
        "middle_name": "RENEE",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-02",
        "last_updated": "2021-09-02",
        "certification_date": "2021-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "338534",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "976965613",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Unknown",
            "affiliation": "N",
            "address_1": "1376 E Delavan Ave Uppr",
            "city": "Buffalo",
            "state": "NY",
            "country_code": "US",
            "postal_code": "142153980",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.