| Organization Name: | MY PRACTITONER FAMILY PRACTICE |
| NPI Number: | 1053657098 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KATHY SUE BROCK (OWNER) |
| Mailing Address: | 2996 State Route 132 Amelia |
| State: | OH US |
| Postal Code: | 451022404 |
| Phone Number: | 5137480874 |
| Fax Number: | 5133227989 |
| NPI Enumeration Date: | 12/19/2012 |
| NPI Last Update Date: | 07/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SF0001X |
| License Number: | COA.13223-NP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Family Health |
| Taxonomy Definition: | |