Provider Demographics
NPI:1487742953
Name:BROOKS-ROCK, KATHY (FNP)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:BROOKS-ROCK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MOOSEHEAD TRL
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NEWPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04953-4020
Mailing Address - Country:US
Mailing Address - Phone:207-368-4213
Mailing Address - Fax:207-355-3033
Practice Address - Street 1:333 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CANAAN
Practice Address - State:ME
Practice Address - Zip Code:04929
Practice Address - Country:US
Practice Address - Phone:207-414-6990
Practice Address - Fax:207-474-8899
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER026591363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM8925Medicare ID - Type Unspecified
MEQ56114Medicare UPIN