Provider Demographics
NPI:1215534193
Name:BROOKMAN, RICHARD JR
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BROOKMAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:ALDERSON
Mailing Address - State:WV
Mailing Address - Zip Code:24910-0190
Mailing Address - Country:US
Mailing Address - Phone:304-667-4271
Mailing Address - Fax:
Practice Address - Street 1:252 SOUTH MONROE
Practice Address - Street 2:
Practice Address - City:ALDEERSON
Practice Address - State:WV
Practice Address - Zip Code:24910
Practice Address - Country:US
Practice Address - Phone:304-667-4271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant