My Practitoner Family Practice

Primary specialty

Family Health Clinical Nurse SpecialistTaxonomy code 364SF0001X

License

COA.13223-NP Issued in OH

Legal business name

MY PRACTITONER FAMILY PRACTICE

Practice address

2996 State Route 132
Amelia, OH 45102-2404

Phone

(513) 748-0874

Fax

(513) 322-7989

NPI assigned

Dec 19, 2012

Organization subpart

No

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

Authorized official

Name

Kathy Sue Brock, NP

Title

Owner

Phone

(513) 748-0874

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1355875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374192000000",
    "number": "1053657098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2996 STATE ROUTE 132",
            "city": "AMELIA",
            "state": "OH",
            "postal_code": "451022404",
            "telephone_number": "513-748-0874",
            "fax_number": "513-322-7989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2996 STATE ROUTE 132",
            "city": "AMELIA",
            "state": "OH",
            "postal_code": "451022404",
            "telephone_number": "513-748-0874",
            "fax_number": "513-322-7989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY PRACTITONER FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-19",
        "last_updated": "2013-07-19",
        "status": "A",
        "authorized_official_last_name": "BROCK",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "513-748-0874",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "364SF0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": "OH",
            "license": "COA.13223-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Amelia, OH by specialty
• Family Health Clinical Nurse Specialist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2013; 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.