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General NPI Number Information
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NPI Number | 1942748736
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Entity Type | Individual
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Provider Name | KIMBERLY CROCKETT BRASURE NP-C
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Gender | Female
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Dates
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Enumeration Date | 02/01/2017
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 35998 ZION CHURCH RD UNIT 1
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City | FRANKFORD
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State | DE
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Zip | 19945-4501
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Country | US
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Telephone | 302-278-0093
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Fax | 302-278-0096
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Provider Business Mailing Address
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Address Line | 31707 BRASURE RD
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City | DAGSBORO
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State | DE
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Zip | 19939-4172
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Country | US
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Telephone | 302-278-0093
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Fax | 302-278-0096
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | LG0001010
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License Number State | DE
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