Healthcare Provider Details

I. General information

NPI: 1053876573
Provider Name (Legal Business Name): BROOKE THOUVENOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 N MAIN ST
LANSING KS
66043-1305
US

IV. Provider business mailing address

715 SOUTHWIND DR
JUNCTION CITY KS
66441-9021
US

V. Phone/Fax

Practice location:
  • Phone: 913-250-5155
  • Fax: 913-250-5515
Mailing address:
  • Phone: 785-209-3779
  • Fax: 785-209-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number14-133740-051
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2019004291
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-80720-051
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number2009026463
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: