Healthcare Provider Details

I. General information

NPI: 1013744630
Provider Name (Legal Business Name): BROOKE KING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 12/28/2025
Certification Date: 12/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N 3RD STREET HEALTH NORTH BUILDING, 3RD FLOOR
PHOENIX AZ
85004
US

IV. Provider business mailing address

550 N 3RD STREET HEALTH NORTH BUILDING, 3RD FLOOR
PHOENIX AZ
85004
US

V. Phone/Fax

Practice location:
  • Phone: 602-496-0907
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number247655
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: