Healthcare Provider Details

I. General information

NPI: 1144134321
Provider Name (Legal Business Name): BROOKE CORDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

10803 DEERING RD
LOUISVILLE KY
40272-4127
US

IV. Provider business mailing address

4310 NACHAND LN
LOUISVILLE KY
40218-2846
US

V. Phone/Fax

Practice location:
  • Phone: 859-375-9200
  • Fax:
Mailing address:
  • Phone: 502-821-9520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: