Active NPI
Jamie Kathryn Brake
- Behavior Technician
- Masonic Home, KY
National Provider Identifier
1346064193
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- B20-378-64C
- Practice address
- 3761 Johnson Hall Dr
Masonic Home, KY 40041-9998 - Phone
- (502) 293-1695
- NPI assigned
- Nov 8, 2024
- Last updated
- Nov 8, 2024
- 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | B20-378-64C | KY | Primary |
Addresses
Primary practice location
3761 Johnson Hall Dr
Masonic Home, KY 40041-9998
Mailing address
1312 Oak Ridge CT
Simpsonville, KY 40067-6668
Phone (502) 321-7590
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| B20-378-64C | KY | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1731024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731024000000",
"number": "1346064193",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1312 OAK RIDGE CT",
"city": "SIMPSONVILLE",
"state": "KY",
"postal_code": "400676668",
"telephone_number": "502-321-7590"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3761 JOHNSON HALL DR",
"city": "MASONIC HOME",
"state": "KY",
"postal_code": "400419998",
"telephone_number": "502-293-1695"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAKE",
"first_name": "JAMIE",
"middle_name": "KATHRYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-11-08",
"last_updated": "2024-11-08",
"certification_date": "2024-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "KY",
"license": "B20-378-64C",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Masonic Home, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.