MEDICARE: MR. AUSTIN NICHOLAS BROOKS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA2836	KY

General Provider Information

NPI Number	:	1013668086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AUSTIN NICHOLAS BROOKS PA

Provider Business Mailing Address
First Line	:	148 HOLLY GROVE RD
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40701-4426
Country	:	US
Telephone Number	:	865-585-0863
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 KEYSTONE DR STE 5
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-7988
Country	:	US
Telephone Number	:	859-353-8884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2022
Last Update Date	:	01/12/2022

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