MRS. KYMBERLI RAYE BROCK NP-C NPI 1619972478

NPI Information

NPI: 1619972478
Provider Name: MRS. KYMBERLI RAYE BROCK, NP-C
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

Organization: MOOSE CREEK MEDICAL CLINIC LLC

PECOS Registration: Yes

Address:
3841 PIPER ST
SUITE T100
ANCHORAGE, AK
ZIP 99508
Phone: (907) 561-3211
Get Directions

MRS. Kymberli Raye Brock, NP-C is a family nurse practitioner in Anchorage, AK with 22 years of experience. MRS. Kymberli Raye Brock, NP-C NPI is 1619972478. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3841 PIPER ST
SUITE T100
ANCHORAGE, AK
ZIP 99508-624
Phone: (907) 561-3211
Fax: (907) 562-7547

The NPI 1619972478 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/17/2005 and was last updated on 10/29/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LA2200X	Nurse Practitioner	Adult Health	NP-586A	IDAHO	No
2	363LF0000X	Nurse Practitioner	Family	1073	ALASKA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000010147885	OTHER		BLUE SHIELD
2	K162319	MEDICARE PIN	ALASKA
3	1344029	MEDICARE ID-TYPE UNSPECIFIED	IDAHO
4	1022256	MEDICAID	ALASKA
5	806735600	MEDICAID	IDAHO
6	P87678	MEDICARE UPIN	IDAHO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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