Individual provider Active NPI

Katherine Marie Brock, FNP

  • Family Nurse Practitioner
  • Cheyenne, WY
National Provider Identifier
1124863089
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
43387 Issued in WY
Practice address
2301 House Ave Ste 301
Cheyenne, WY 82001-3178
Phone
(307) 637-1600
NPI assigned
Jul 1, 2024
Last updated
Oct 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 43387 WY Primary

Addresses

Primary practice location

2301 House Ave Ste 301
Cheyenne, WY 82001-3178

Mailing address

4500 Cleveland Ave
Cheyenne, WY 82001-2010

Other practice location 1

214 E 23rd St
Cheyenne, WY 82001-3748
Phone (307) 634-2273

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kbrock37791@direct.crmcwy.org Health Information Exchange (HIE) Cheyenne Regional Physicians Group, LLC
Direct Messaging Address kbrock37791@direct.crmcwy.org Direct Cheyenne Regional Physicians Group, LLC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240716004447 WY Practitioner - Nurse Practitioner 3678018439 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cheyenne Regional Physicians Group LLCGroup PAC ID 2961403639, 101 clinicians

Practice addresses (Care Compare)

2301 House Ave
Suite 301
Cheyenne, WY 82001-3178
Phone (307) 637-1600

4116 Laramie St
Cheyenne, WY 82001-1969
Phone (307) 635-7961

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
43387WYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cheyenne Regional Physicians Group, LLC CurrentSince Aug 19, 2024 Accepting new patients
Cheyenne Children's Clinic, PC Past Accepting new patients

Locations

214 E 23rd St
Cheyenne, WY 82001
Phone (307) 324-2221

2301 House Ave
Ste 301
Cheyenne, WY 82001
Phone (307) 637-1600

4116 Laramie St
Cheyenne, WY 82001
Phone (307) 634-9311

Interoperability endpoints

  • Direct secure messaging: kbrock37791@direct.crmcwy.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1719792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1124863089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 CLEVELAND AVE",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820012010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 HOUSE AVE STE 301",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820013178",
            "telephone_number": "307-637-1600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "214 E 23rd St",
            "address_purpose": "LOCATION",
            "city": "Cheyenne",
            "state": "WY",
            "postal_code": "820013748",
            "country_code": "US",
            "telephone_number": "307-634-2273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROCK",
        "first_name": "KATHERINE",
        "middle_name": "MARIE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-01",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WY",
            "license": "43387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kbrock37791@direct.crmcwy.org",
            "affiliation": "Y",
            "endpointDescription": "CRMC Direct Address",
            "affiliationName": "Cheyenne Regional Physicians Group, LLC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2301 House Ave Ste 301",
            "city": "Cheyenne",
            "state": "WY",
            "country_code": "US",
            "postal_code": "820013178",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kbrock37791@direct.crmcwy.org",
            "affiliation": "Y",
            "endpointDescription": "CRMC Direct Address",
            "affiliationName": "Cheyenne Regional Physicians Group, LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2301 House Ave Ste 301",
            "city": "Cheyenne",
            "state": "WY",
            "country_code": "US",
            "postal_code": "820013178",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cheyenne, WY

Sources for this page

Verify at the official NPI Registry.