Individual provider Active NPI

Katherine Joan Brock, FNP

  • Nurse Practitioner
  • Wilmington, NC
National Provider Identifier
1992378889
Registry record updated Oct 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5014739 Issued in NC
Practice address
1520 Physicians Dr
Wilmington, NC 28401-7356
Phone
(910) 662-8300
Fax
(910) 662-8361
NPI assigned
Jul 20, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5014739 NC Primary

Addresses

Primary practice location

1520 Physicians Dr
Wilmington, NC 28401-7356

Mailing address

PO Box 936857
Atlanta, GA 31193-6857
Phone (910) 662-8300

Other practice location 1

1520 Physicians Dr
Wilmington, NC 28401-7356
Phone (910) 662-8300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210930001812 NC Practitioner - Nurse Practitioner 6608273859 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1520 Physicians Dr
Wilmington, NC 28401-7356
Phone (910) 662-8300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5014739NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group Coastal Region, LLC CurrentSince Sep 24, 2021 Accepting new patients
NMG Health Services LLC CurrentSince Sep 24, 2021 Accepting new patients
Novant Health Medical Group Coastal Region, LLC Current Accepting new patients
New Hanover Medical Group PA Past Accepting new patients

Locations

800 Jefferson St
Ste 112
Whiteville, NC 28472
Phone (910) 642-8164

1520 Physicians Dr
Wilmington, NC 28401
Phone (910) 662-8300

109 Scotts Hill Medical Dr
Ste 204
Wilmington, NC 28411
Phone (910) 662-1960

Interoperability endpoints

  • Direct secure messaging: kbrock1459863@direct.novanthealth.org

Organizations & group practices 4

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1626739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634688000000",
    "number": "1992378889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 936857",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311936857",
            "telephone_number": "910-662-8300",
            "fax_number": "910-662-8361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 PHYSICIANS DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017356",
            "telephone_number": "910-662-8300",
            "fax_number": "910-662-8361"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1520 Physicians Dr",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284017356",
            "country_code": "US",
            "telephone_number": "910-662-8300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROCK",
        "first_name": "KATHERINE",
        "middle_name": "JOAN",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-20",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5014739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.