Active NPI
Kathleen Pearl Broderick, RN
- Registered Nurse
- Auburn, NY
National Provider Identifier
1104929454
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 490767-1
- Practice address
- 146 North Street
Auburn, NY 13021-3461 - Phone
- (315) 253-0341
- Fax
- (315) 253-1129
- NPI assigned
- Sep 5, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 490767-1 | NY | Primary |
Addresses
Primary practice location
146 North Street
Auburn, NY 13021-3461
Mailing address
PO Box 512
Red Creek, NY 13143-0232
Phone (315) 297-0844
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 490767-1 | NY | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389571200000",
"number": "1104929454",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 512",
"city": "RED CREEK",
"state": "NY",
"postal_code": "131430232",
"telephone_number": "315-297-0844"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "146 NORTH STREET",
"city": "AUBURN",
"state": "NY",
"postal_code": "130213461",
"telephone_number": "315-253-0341",
"fax_number": "315-253-1129"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODERICK",
"first_name": "KATHLEEN",
"middle_name": "PEARL",
"name_prefix": "Ms.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-05",
"last_updated": "2014-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "490767-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Auburn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 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.