Provider Demographics
NPI:1114266541
Name:CARPENTER, BROOKE E (APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:E
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:MS
Other - First Name:BROOKE
Other - Middle Name:E
Other - Last Name:BONOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-912-7211
Mailing Address - Fax:859-655-8981
Practice Address - Street 1:85 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1793
Practice Address - Country:US
Practice Address - Phone:859-912-7211
Practice Address - Fax:859-655-6674
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007817363LF0000X, 363L00000X
OH330723363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0080524Medicaid
KYP01516729OtherRR MEDICARE
KY7100239690Medicaid
OH0080524Medicaid