Healthcare Provider Details

I. General information

NPI: 1881546802
Provider Name (Legal Business Name): BROOKE A GREEN DNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6648 N VIEWPOINT DR STE 5
PRESCOTT VALLEY AZ
86315-4942
US

IV. Provider business mailing address

6648 N VIEWPOINT DR STE 5
PRESCOTT VALLEY AZ
86315-4942
US

V. Phone/Fax

Practice location:
  • Phone: 928-708-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF08260449
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: