MEDICARE: KURSTYN BROCK APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	4015863	KY
2	363L00000X	Nurse Practitioner	71015152A	IN

General Provider Information

NPI Number	:	1790538692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KURSTYN BROCK APRN

Provider Business Mailing Address
First Line	:	17105 MEANDER WAY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40245-4416
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 STATE ST
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-4990
Country	:	US
Telephone Number	:	812-945-7536
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2024
Last Update Date	:	02/25/2026

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Directions to “ KURSTYN BROCK APRN” Practice Location

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