MEDICARE: BROOKE ANDERSON BOST PA-C

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	207RS0012X	Sleep Medicine (Internal Medicine) Physician	0010-11433	NC
2	363A00000X	Physician Assistant	0010-11433	NC

General Provider Information

NPI Number	:	1306518014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE ANDERSON BOST PA-C

Provider Business Mailing Address
First Line	:	932 AIRPORT RHODHISS RD
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28601-7101
Country	:	US
Telephone Number	:	828-850-7859
Fax Number	:

Provider Business Practice Location Address
First Line	:	270 PINE MOUNTAIN RD
Second Line	:
City	:	HUDSON
State	:	NC
Zip	:	28638-2605
Country	:	US
Telephone Number	:	828-757-8206
Fax Number	:

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

Provider Enumeration Date	:	09/30/2021
Last Update Date	:	11/16/2021

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