MEDICARE: JOSEPH BROOKS

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	363LF0000X	Family Nurse Practitioner	APRN11010350	FL
2	363LF0000X	Family Nurse Practitioner	3008699	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	12704008	OTHER		CAQH

General Provider Information

NPI Number	:	1619381092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH BROOKS

Provider Business Mailing Address
First Line	:	PO BOX 125
Second Line	:
City	:	MOUNT WASHINGTON
State	:	KY
Zip	:	40047-0125
Country	:	US
Telephone Number	:	502-357-9211
Fax Number	:	502-576-7400

Provider Business Practice Location Address
First Line	:	2233 LOWER HUNTERS TRCE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-1358
Country	:	US
Telephone Number	:	502-357-9211
Fax Number	:	502-576-7400

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

Provider Enumeration Date	:	06/13/2014
Last Update Date	:	12/06/2024

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