Karlyn Nichelle Brockenbrough, CRNP

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

AC006649 Issued in MD

Practice address

19650 Club House Rd # 101
Montgomery Village, MD 20886-3003

Phone

(301) 208-1300

Fax

(301) 208-8699

NPI assigned

Jul 2, 2024

Last updated

Sep 25, 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1719878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790294400000",
    "number": "1720824592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 4TH ST NE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200023431",
            "telephone_number": "202-347-8512",
            "fax_number": "202-506-5372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19650 CLUB HOUSE RD # 101",
            "city": "MONTGOMERY VILLAGE",
            "state": "MD",
            "postal_code": "208863003",
            "telephone_number": "301-208-1300",
            "fax_number": "301-208-8699"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5001 Silver Hill Rd Ste 103",
            "address_purpose": "LOCATION",
            "city": "Suitland",
            "state": "MD",
            "postal_code": "207465208",
            "country_code": "US",
            "telephone_number": "240-563-1220",
            "fax_number": "240-619-3050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROCKENBROUGH",
        "first_name": "KARLYN",
        "middle_name": "NICHELLE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-02",
        "last_updated": "2026-09-25",
        "certification_date": "2026-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "MD",
            "license": "AC006649",
            "primary": true
        },
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "MD",
            "license": "AC006649",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Women's Health Nurse Practitioner in Montgomery Village, MD
• Providers in Montgomery Village, MD by specialty
• Women's Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2026; 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.