Provider Demographics
NPI:1720824592
Name:BROCKENBROUGH, KARLYN NICHELLE (CRNP)
Entity type:Individual
Prefix:
First Name:KARLYN
Middle Name:NICHELLE
Last Name:BROCKENBROUGH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WINDING RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-8600
Mailing Address - Country:US
Mailing Address - Phone:302-419-4888
Mailing Address - Fax:
Practice Address - Street 1:21 WINDING RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-8600
Practice Address - Country:US
Practice Address - Phone:302-419-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC006649363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology