Healthcare Provider Details

I. General information

NPI: 1326800335
Provider Name (Legal Business Name): BROOKE NICOLE MCPEAK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S PARK ST
EL DORADO SPRINGS MO
64744-2037
US

IV. Provider business mailing address

1401 S PARK ST
EL DORADO SPRINGS MO
64744-2037
US

V. Phone/Fax

Practice location:
  • Phone: 417-876-2511
  • Fax: 417-876-3812
Mailing address:
  • Phone: 417-876-2511
  • Fax: 417-876-3812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2024002082
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: