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NPI Code Detail

MEDICARE: MARIETTA BROOKS APRN

MEDICARE: MARIETTA BROOKS APRN
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
1363LF0000XFamily Nurse Practitioner3011740KY

General Provider Information

NPI Number : 1275042145
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIETTA BROOKS APRN
Provider Business Mailing Address
First Line : 803 MEYERS BAKER RD STE 200
Second Line :
City : LONDON
State : KY
Zip : 40741-3040
Country : US
Telephone Number : 606-878-3240
Fax Number : 606-878-3245
Provider Business Practice Location Address
First Line : 803 MEYERS BAKER RD STE 200
Second Line :
City : LONDON
State : KY
Zip : 40741-3040
Country : US
Telephone Number : 606-878-3240
Fax Number : 606-878-3245
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2017
Last Update Date : 07/21/2022

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Directions to “ MARIETTA BROOKS APRN” Practice Location

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