Kristin Bruckman, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN.CNP.0038456 Issued in OH

Practice address

5412 Courseview Dr Ste 215
Mason, OH 45040-2410

Phone

(513) 204-1910

NPI assigned

Feb 10, 2025

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Lee Side Wellness Associates, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Mason, OH
  • NPI 1841731510
  Medicare reassignment NPD
• Psycho Social Therapies,LTD

  • Clinical Social Worker
  • Beachwood, OH
  • NPI 1750335261
  Medicare reassignment NPD
• Psycho Social Therapies,LTD

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Beachwood, OH
  • NPI 1902462906
  NPD

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

{
    "created_epoch": "1739145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739145600000",
    "number": "1689489510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4095 BROOKDALE LN UNIT 6",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454404187",
            "telephone_number": "937-361-0192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5412 COURSEVIEW DR STE 215",
            "city": "MASON",
            "state": "OH",
            "postal_code": "450402410",
            "telephone_number": "513-204-1910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCKMAN",
        "first_name": "KRISTIN",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-02-10",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "APRN.CNP.0038456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Livesay Broering, M.D.
• Ronald Brooks
• Cassandra Pearl Brown
• Lisa Michelle Brown, RPH
• Stephen Brown, LSW
• Renee Lynn Brugger, PHARMD, RPH
• Maricarmen Brugueras Narvaez
• Sara Brumagen
• Jeanine Ann Bryant, OTR/L
• Tiffany Nichelle Bryant, LPCC

• Psychiatric/Mental Health Nurse Practitioner in Mason, OH
• Providers in Mason, OH by specialty
• Psychiatric/Mental Health Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.