REBECCA BRANDENBURG, APRN- CNP — NPI 1104393925 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric

CMS-1500 Box 24J / 33a • NPI

1104393925

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

363LP0808X (CMS 50)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health

Box 32 Service Location & ZIP+4

305 ESTILL ST, BEREA, KY, 40403-1742

✓ 9-Digit EDI 837 ZIP+4 (40403-1742)

Practice Phone & Referral Fax

(859) 985-1415

Fax: (859) 986-6752

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1104393925 (REBECCA BRANDENBURG, APRN- CNP) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1104393925` (NPI-1 Individual Practitioner)
Provider / Legal Name	REBECCA BRANDENBURG, APRN- CNP
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health NUCC Code: `363LP0808X` (Nurse Practitioner, Psych/Mental Health)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	305 ESTILL ST, BEREA, KY, 40403-1742
Practice Telephone / Fax	Tel: (859) 985-1415 \| Fax: (859) 986-6752
Administrative Mailing Address	1010 MAIN ST S, MC KEE, KY, 40447-7089
Enumeration & Last Sync	Enumerated: 2018-10-30 \| CMS Record Updated: 2024-03-26

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

305 ESTILL ST, BEREA, KY, 40403-1742

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Plain-English Taxonomy & CMS Crosswalk (363LP0808X)

What Does Taxonomy Code 363LP0808X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LP0808X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 50 (Nurse Practitioner)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Nurse Practitioner, Psych/Mental Health for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (REBECCA BRANDENBURG, APRN- CNP)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`363LF0000X` — Nurse Practitioner, Family Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family	State: KY \| License: `3012601` \| Primary: Secondary
`363LP0808X` — Nurse Practitioner, Psych/Mental Health Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health	State: KY \| License: `3012601` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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REBECCA BRANDENBURG, APRN- CNP (NPI #1104393925)