Provider Demographics
NPI:1942748736
Name:BRASURE, KIMBERLY CROCKETT (NP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CROCKETT
Last Name:BRASURE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31707 BRASURE RD
Mailing Address - Street 2:
Mailing Address - City:DAGSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19939-4172
Mailing Address - Country:US
Mailing Address - Phone:302-278-0093
Mailing Address - Fax:302-278-0096
Practice Address - Street 1:35998 ZION CHURCH RD UNIT 1
Practice Address - Street 2:
Practice Address - City:FRANKFORD
Practice Address - State:DE
Practice Address - Zip Code:19945-4501
Practice Address - Country:US
Practice Address - Phone:302-278-0093
Practice Address - Fax:302-278-0096
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG0001010363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner