Active NPI
Kimber Ann Brokaw, L.I.S.W
- Social Worker
- Bettendorf, IA
National Provider Identifier
1932394046
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 04505
- Practice address
- 1035 Lincoln Rd
Suite 202
Bettendorf, IA 52722-4198 - Phone
- (563) 424-7137
- NPI assigned
- Sep 11, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 04505 | IA | Primary |
Addresses
Primary practice location
1035 Lincoln Rd
Suite 202
Bettendorf, IA 52722-4198
Mailing address
164 15TH Ave
Moline, IL 61265-2925
Phone (309) 269-8810
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 20, 2026 through Apr 20, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04505 | IA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189468800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1426377600000",
"number": "1932394046",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "164 15TH AVE",
"city": "MOLINE",
"state": "IL",
"postal_code": "612652925",
"telephone_number": "309-269-8810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1035 LINCOLN RD",
"address_2": "SUITE 202",
"city": "BETTENDORF",
"state": "IA",
"postal_code": "527224198",
"telephone_number": "563-424-7137"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROKAW",
"first_name": "KIMBER",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "L.I.S.W",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-09-11",
"last_updated": "2015-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IA",
"license": "04505",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bettendorf, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.