Healthcare Provider Details

I. General information

NPI: 1114266541
Provider Name (Legal Business Name): BROOKE E. CARPENTER APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. BROOKE E. BONOW

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 N GRAND AVE
FORT THOMAS KY
41075-1793
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-912-7211
  • Fax: 859-655-6674
Mailing address:
  • Phone: 859-912-7211
  • Fax: 859-655-8981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3007817
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007817
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number330723
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: