Kimberly Ann Brozak, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

COA.14576-NP Issued in OH

Practice address

5 Charles St
Athens, OH 45701-2329

Phone

(855) 472-4633

Fax

(740) 447-9016

NPI assigned

Jun 19, 2013

Last updated

Mar 11, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kimberly Ann Gibson-Lake Former name

Medicare fee-for-service enrollment

Enrolled in OH

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

Specialty

Nurse Practitioner

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Integrated Services for Behavioral HealthGroup PAC ID 9234372525, 39 clinicians

Fairfield Community Health CenterGroup PAC ID 9133316805, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/isaoh/r4/

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.

• Integrated Services for Behavioral Health

  • Clinical Social Worker
  • Nelsonville, OH
  • NPI 1073578431
  Medicare reassignment Care Compare group NPD
• Fairfield Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Lancaster, OH
  • NPI 1457676736
  Medicare reassignment Care Compare group
• Ohio Emergency Professionals Inc

  • Emergency Medicine Physician
  • Columbus, OH
  • NPI 1982983425
  Medicare reassignment NPD
• Integrated Services for Behavioral Health

  • Community/Behavioral Health Agency
  • Nelsonville, OH
  • NPI 1205196201
  NPD (past)

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

{
    "created_epoch": "1371600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773187200000",
    "number": "1568801975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 CHARLES ST",
            "city": "ATHENS",
            "state": "OH",
            "postal_code": "457012329",
            "telephone_number": "855-472-4633",
            "fax_number": "740-447-9016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 CHARLES ST",
            "city": "ATHENS",
            "state": "OH",
            "postal_code": "457012329",
            "telephone_number": "855-472-4633",
            "fax_number": "740-447-9016"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "220 E Walnut St",
            "address_purpose": "LOCATION",
            "city": "Lancaster",
            "state": "OH",
            "postal_code": "431304464",
            "country_code": "US",
            "telephone_number": "740-277-6043",
            "fax_number": "740-277-7595",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROZAK",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-19",
        "last_updated": "2026-03-11",
        "certification_date": "2026-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "COA.14576-NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0086503",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "GIBSON-LAKE",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shelly Lee Brown, CNP
• Theodore Brown
• Travis Brown
• Noah Browning
• Daniel Brozak
• Katie Bruce, CDCA
• Tracie Bruce
• Emily Bruch
• Katherine R Bruno
• Reece Brunton

• Family Nurse Practitioner in Athens, OH
• Providers in Athens, OH by specialty
• Family Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.