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NPI Code Detail

MEDICARE: BROOKE CARLYLE APRN, PMHNP

MEDICARE: BROOKE CARLYLE APRN, PMHNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner2018019839MO

General Provider Information

NPI Number : 1316430440
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE CARLYLE APRN, PMHNP
Provider Business Mailing Address
First Line : 123 SMITH AVE
Second Line :
City : SIKESTON
State : MO
Zip : 63801-5239
Country : US
Telephone Number : 573-471-0200
Fax Number : 573-481-2209
Provider Business Practice Location Address
First Line : 123 SMITH AVE
Second Line :
City : SIKESTON
State : MO
Zip : 63801-5239
Country : US
Telephone Number : 573-471-0200
Fax Number : 573-481-2209
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2018
Last Update Date : 06/08/2020

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