Provider Demographics
NPI:1073775029
Name:CALHOUN, BROOKE C (NP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:C
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:6626 E. 75TH STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-621-4139
Mailing Address - Fax:317-621-7885
Practice Address - Street 1:8101 CLEARVISTA PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4675
Practice Address - Country:US
Practice Address - Phone:317-621-5390
Practice Address - Fax:317-621-7885
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71002662A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01014108OtherRR MEDICARE PTAN
IN200956010Medicaid
INM400037723Medicare PIN
IN200956010Medicaid