Acadia Healthcare Inc

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP7850 Issued in AZ

Legal business name

ACADIA HEALTHCARE INC

Practice address

2699 E Andy Devine
Suite B
Kingman, AZ 86401
UM

Phone

(928) 753-7107

NPI assigned

Nov 30, 2016

Last updated

Nov 30, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jeri Lynn Brock, DCNPI 1356322739

Title

President

Phone

(928) 530-4546

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeri Lynn Brock, D.C.

  • Chiropractor
  • Kingman, AZ
  • NPI 1356322739
  NPD (past) Authorized official

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

{
    "created_epoch": "1480464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480464000000",
    "number": "1710420286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 RIATA VALLEY RD",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864092976",
            "telephone_number": "928-530-4546"
        },
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "LOCATION",
            "address_type": "FGN",
            "address_1": "2699 E ANDY DEVINE",
            "address_2": "SUITE B",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "86401",
            "telephone_number": "928-753-7107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACADIA HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-30",
        "last_updated": "2016-11-30",
        "status": "A",
        "authorized_official_last_name": "BROCK",
        "authorized_official_first_name": "JERI",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "928-530-4546",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP7850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2016; 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.