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General NPI Number Information
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NPI Number | 1528707452
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Entity Type | Individual
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Provider Name | BROOKE BEARDEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/31/2022
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 595 BUCKINGHAM WAY STE 505
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City | SAN FRANCISCO
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State | CA
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Zip | 94132-1913
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Country | US
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Telephone | 415-294-4090
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Fax |
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Provider Business Mailing Address
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Address Line | 100 MEADOWCREEK DR STE 115
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City | CORTE MADERA
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State | CA
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Zip | 94925-1230
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Country | US
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Telephone | 415-202-5390
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA61238
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License Number State | CA
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