Healthcare Provider Details

I. General information

NPI: 1699370247
Provider Name (Legal Business Name): KRISTIN CAROL BROCKMAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 W ANDREWS AVE
HENDERSON NC
27536-2532
US

IV. Provider business mailing address

932 W ANDREWS AVE
HENDERSON NC
27536-2532
US

V. Phone/Fax

Practice location:
  • Phone: 252-572-2625
  • Fax:
Mailing address:
  • Phone: 252-572-2625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5013829
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5013829
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number229054
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: