Physician Compare National (NPI:1942748736)

HEALTHCARE PROVIDER: KIMBERLY CROCKETT BRASURE NP-C

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1942748736
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7214213024
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170410002404
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BRASURE
	Individual professional last name
Provider First Name	KIMBERLY
	Individual professional first name
Provider Middle Name	CROCKETT
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2014
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	35998 ZION CHURCH RD
	Group Practice or individual's line 1 address
Line 2 Street Address	UNIT 1
	Group Practice or individual's line 2 address
City	FRANKFORD
	Group Practice or individual's city
State	DE
	Group Practice or individual's state
Zip Code	199454501
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	080007
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BEEBE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	210019
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	PENINSULA REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	210061
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ATLANTIC GENERAL HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y