Provider Demographics
NPI:1134657851
Name:AYERSMAN, BROOKLYN JO (FNP)
Entity Type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:JO
Last Name:AYERSMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 MACOMBER CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ROWLESBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26425-9239
Mailing Address - Country:US
Mailing Address - Phone:304-771-1256
Mailing Address - Fax:
Practice Address - Street 1:411 MORGANTOWN ST
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-1095
Practice Address - Country:US
Practice Address - Phone:304-329-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN73735NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily