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General NPI Number Information
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NPI Number | 1972144608
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Entity Type | Individual
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Provider Name | BROOKE ASHTON KENNON DNP APRN AG-ACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/03/2019
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 6025 WALNUT GROVE RD STE 301
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City | MEMPHIS
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State | TN
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Zip | 38120-2123
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Country | US
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Telephone | 901-226-0456
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 405827
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City | ATLANTA
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State | GA
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Zip | 30384-5827
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Country | US
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Telephone | 901-226-3186
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 26355
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License Number State | TN
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