Active NPI
Keisha Brockington
- Licensed Practical Nurse
- Bronx, NY
National Provider Identifier
1538429220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 306591-1
- Practice address
- 3924 E Tremont Ave
Bronx, NY 10465-2900 - Phone
- (718) 409-6500
- Fax
- (718) 239-1294
- NPI assigned
- May 29, 2012
- Last updated
- May 29, 2012
- 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 |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 306591-1 | NY | Primary |
Addresses
Primary practice location
3924 E Tremont Ave
Bronx, NY 10465-2900
Mailing address
3924 E Tremont Ave
Bronx, NY 10465-2900
Phone (718) 409-6500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 070778 | Medicaid | NY |
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 |
|---|---|---|---|
| 306591-1 | NY | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338249600000",
"number": "1538429220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3924 E TREMONT AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104652900",
"telephone_number": "718-409-6500",
"fax_number": "718-239-1294"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3924 E TREMONT AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104652900",
"telephone_number": "718-409-6500",
"fax_number": "718-239-1294"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCKINGTON",
"first_name": "KEISHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-05-29",
"last_updated": "2012-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "306591-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "070778",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.