MEDICARE: KIMBERLY ANN BROZAK NURSE PRACTITIONER

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	363LF0000X	Family Nurse Practitioner	COA.14576-NP	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568801975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANN BROZAK NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	5 CHARLES ST
Second Line	:
City	:	ATHENS
State	:	OH
Zip	:	45701-2329
Country	:	US
Telephone Number	:	855-472-4633
Fax Number	:	740-447-9016

Provider Business Practice Location Address
First Line	:	5 CHARLES ST
Second Line	:
City	:	ATHENS
State	:	OH
Zip	:	45701-2329
Country	:	US
Telephone Number	:	855-472-4633
Fax Number	:	740-447-9016

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

Provider Enumeration Date	:	06/19/2013
Last Update Date	:	03/11/2026

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