Kristin Carol Brockman, NP-C

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

5013829 Issued in NC

Practice address

2101 Garner Rd
Raleigh, NC 27610-0114

Phone

(919) 787-6131

NPI assigned

Dec 2, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1606867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634083200000",
    "number": "1699370247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 GARNER RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276100114",
            "telephone_number": "919-787-6131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 GARNER RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276100114",
            "telephone_number": "919-787-6131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCKMAN",
        "first_name": "KRISTIN",
        "middle_name": "CAROL",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-02",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "229054",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5013829",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "5013829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "brockmank@southlight.org",
            "affiliation": "N",
            "address_1": "2101 Garner Rd",
            "city": "Raleigh",
            "state": "NC",
            "country_code": "US",
            "postal_code": "276100114",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lakeshia Brock
• Lauren Michelle Brock, M.S. CCC-SLP
• Meissa Davis Brock, LCAS
• Robert Hudgins Brock, LPC-A
• Catherine Brocker
• Michael Broder
• Allison Kay Porter Broderick, PA
• Whitney Brodie
• Gemma Kate Brodney, RBT
• Mindy Beth Brodsky, LCSWA, LCSW, ESQ.

• Psychiatric/Mental Health Nurse Practitioner in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Psychiatric/Mental Health Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.