Kelly Marie Timbrook, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71010093A Issued in IN

Practice address

1717 S Calhoun St
Fort Wayne, IN 46802-5257

Phone

(260) 458-3093

Fax

(260) 458-3093

NPI assigned

Jun 11, 2020

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kelly.timbrook.2@30520.direct.athenahealth.com

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.

• Neighborhood Health Clinics, Inc

  • Clinic/Center
  • Fort Wayne, IN
  • NPI 1548291222
  Medicare reassignment NPD
• Neighborhood Health Clinics, Inc

  • Clinic/Center
  • Fort Wayne, IN
  • NPI 1730989518
  NPD

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

{
    "created_epoch": "1591833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684108800000",
    "number": "1851916274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 S CALHOUN ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468025257",
            "telephone_number": "260-458-2641",
            "fax_number": "260-458-3093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 S CALHOUN ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468025257",
            "telephone_number": "260-458-3093",
            "fax_number": "260-458-3093"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3350 E Paulding Rd",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468164513",
            "country_code": "US",
            "telephone_number": "260-458-2641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIMBROOK",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-11",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71010093A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kvandemark@nhci.org",
            "affiliation": "N",
            "endpointDescription": "encryted work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1717 S Calhoun St",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468025257",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kayla Tigner
• Matthew W Till
• Judy Ann Tillapaugh, RDN LD
• Jordan Michelle Tillman
• Timbrook Psychological Services
• Rodney E Timbrook, PH.D.
• Jason Timmer, CPO
• Angie Timmons, COTA
• Timothy Jay Bussick DDS, Ms, Incorporated
• Timothy L. Johnson Academy

• Family Nurse Practitioner in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; 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.