Balance the Brain Professional Corporation

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

Legal business name

BALANCE THE BRAIN PROFESSIONAL CORPORATION

Practice address

3772 N Mountainoak Dr
Eden, UT 84310

Phone

(419) 559-5904

NPI assigned

Nov 18, 2021

Last updated

Nov 18, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Kelli Kemenah Mauric, RN, WHNP-C, BSN, MSNPI 1245353416

Title

Owner/ President

Phone

(419) 559-5904

Specialties & licenses 1

Addresses

Other identifiers 5

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kelli Kemenah Mauric, WHNP-BC, APRN

  • Women's Health Nurse Practitioner
  • Eden, UT
  • NPI 1245353416
  NPD Authorized official

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

{
    "created_epoch": "1637193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637193600000",
    "number": "1073270666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3772 N MOUNTAINOAK DR",
            "city": "EDEN",
            "state": "UT",
            "postal_code": "84310",
            "telephone_number": "419-559-5904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3772 N MOUNTAINOAK DR",
            "city": "EDEN",
            "state": "UT",
            "postal_code": "84310",
            "telephone_number": "419-559-5904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALANCE THE BRAIN PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-18",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-07",
        "status": "A",
        "authorized_official_last_name": "MAURIC",
        "authorized_official_first_name": "KELLI",
        "authorized_official_middle_name": "KEMENAH",
        "authorized_official_title_or_position": "OWNER/ PRESIDENT",
        "authorized_official_telephone_number": "419-559-5904",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, WHNP-C, BSN, MS"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIMARY TAXONOMY",
            "identifier": "363LW0102X",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SECONDARY TAXONOMY",
            "identifier": "363LW0102X",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BON NP LICENSURE",
            "identifier": "NP-07962",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NP LICENSURE",
            "identifier": "10115460-4405",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PECOS ENROLLMENT ID",
            "identifier": "I20180403001591",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bradley D Benard, PT
• Ashley A Burton, DDS
• Brigham Kenneth Burton, D.D.S.
• Michelle Ashby Cherry, LPC
• CLW DDS PLLC

• Women's Health Nurse Practitioner in Eden, UT
• Providers in Eden, UT by specialty
• Women's Health Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 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.