Healthcare Provider Details

I. General information

NPI: 1063393312
Provider Name (Legal Business Name): BROOKE JANAY HORNBERGER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 N COLLEGE ST
ALBANY MO
64402-1433
US

IV. Provider business mailing address

14 SUMMER DR
PINEDALE WY
82941-7902
US

V. Phone/Fax

Practice location:
  • Phone: 660-726-3941
  • Fax:
Mailing address:
  • Phone: 307-231-2594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2025037859
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: