Heather Brock, Inc

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

751 Issued in AK

Legal business name

HEATHER BROCK, INC

Practice address

851 E Westpoint Dr Ste 302
Wasilla, AK 99654-7183

Phone

(907) 373-5015

Fax

(907) 373-7015

NPI assigned

Jul 27, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Kathleen Gianotti

Title

Billing Manager

Phone

(805) 550-6456

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AK

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Heather Ellison Brock, ANP

  • Nurse Practitioner
  • Anchorage, AK
  • NPI 1992712442

  Psychiatric/Mental Health

  Medicare reassignment NPD

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

{
    "created_epoch": "1185494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708560000000",
    "number": "1538359310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2521 E MOUNTAIN VILLAGE STE B",
            "address_2": "PMB242",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547374",
            "telephone_number": "907-373-5015",
            "fax_number": "907-373-7015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851 E WESTPOINT DR STE 302",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547183",
            "telephone_number": "907-373-5015",
            "fax_number": "907-373-7015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEATHER BROCK, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-27",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A",
        "authorized_official_last_name": "GIANOTTI",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "805-550-6456",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AK",
            "license": "751",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP8919",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Psychiatric/Mental Health Nurse Practitioner in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.