Provider Demographics
NPI:1659243467
Name:MCDERMOTT, KELLI BREANNE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:BREANNE
Last Name:MCDERMOTT
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 1:160 SPRING MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:76082-1140
Mailing Address - Country:US
Mailing Address - Phone:909-573-6213
Mailing Address - Fax:
Practice Address - Street 1:160 SPRING MEADOW DR
Practice Address - Street 2:
Practice Address - City:SPRINGTOWN
Practice Address - State:TX
Practice Address - Zip Code:76082-1140
Practice Address - Country:US
Practice Address - Phone:909-573-6213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1065856163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant