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Organization
MOOSE CREEK MEDICAL CLINIC LLC
Active
Organization
MOOSE CREEK MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMBERLI RAYE BROCK ANP (ADVANCED NURSE PRACTITIONER, BUSINE)
(907) 373-3335
Entity
Organization
Contact information
Practice address
2341 S. FERN ST., SUITE 300, WASILLA, AK 99654
(907) 373-3335
(907) 373-3331
Mailing address
2341 S. FERN ST., SUITE 300, WASILLA, AK 99654
(907) 373-3335
(907) 373-3331
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
—
NULL
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
363LW0102X
Women's Health Nurse Practitioner
—
NULL
363LW0102X
Women's Health Nurse Practitioner
—
—
Other
Enumeration date
12/21/2018
Last updated
12/21/2018
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