Healthcare Provider Details

I. General information

NPI: 1417862590
Provider Name (Legal Business Name): BROOKE MCCUBBINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8134 NEW LAGRANGE RD SUITE 100
LOUISVILLE KY
40222
US

IV. Provider business mailing address

8134 NEW LAGRANGE RD SUITE 100
LOUISVILLE KY
40222
US

V. Phone/Fax

Practice location:
  • Phone: 502-472-7293
  • Fax:
Mailing address:
  • Phone: 502-472-7293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: