Healthcare Provider Details

I. General information

NPI: 1467148494
Provider Name (Legal Business Name): KASEY BROOK SWIONTEK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 N TELSHOR BLVD STE G
LAS CRUCES NM
88011-8234
US

IV. Provider business mailing address

500 SW 7TH ST STE A205
RENTON WA
98057-2983
US

V. Phone/Fax

Practice location:
  • Phone: 877-522-1275
  • Fax: 833-888-7145
Mailing address:
  • Phone: 509-222-1275
  • Fax: 509-491-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number75498
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1138347
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: