Provider Demographics
NPI:1033576046
Name:KERN, BROOKE (AGNP-C)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:KERN
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:KERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HENSEL
Mailing Address - Street 1:7116 157TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-4419
Mailing Address - Country:US
Mailing Address - Phone:507-995-0520
Mailing Address - Fax:
Practice Address - Street 1:10519 165TH ST W
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-5722
Practice Address - Country:US
Practice Address - Phone:952-248-2720
Practice Address - Fax:888-286-9823
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 4378363LG0600X, 363LA2200X
MNR 199769-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse