Active NPI
Kellyrae Brown
- Contractor
- Folsom, CA
National Provider Identifier
1689072316
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 55213
- Practice address
- 1900 Prairie City Rd
Folsom, CA 95630-9501 - Phone
- (916) 370-8154
- NPI assigned
- Dec 11, 2014
- Last updated
- Dec 11, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 55213 | CA | Primary |
Addresses
Primary practice location
1900 Prairie City Rd
Folsom, CA 95630-9501
Mailing address
2404 Loma Vista Dr
Sacramento, CA 95825-0310
Phone (916) 370-8154
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 55213 | CA | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1418256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418256000000",
"number": "1689072316",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2404 LOMA VISTA DR",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958250310",
"telephone_number": "916-370-8154"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 PRAIRIE CITY RD",
"city": "FOLSOM",
"state": "CA",
"postal_code": "956309501",
"telephone_number": "916-370-8154"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROWN",
"first_name": "KELLYRAE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-12-11",
"last_updated": "2014-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "CA",
"license": "55213",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Folsom, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.