Provider Demographics
NPI:1285685180
Name:BROOKINS, JON C (CRNA)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:C
Last Name:BROOKINS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12769 MCR W.5
Mailing Address - Street 2:
Mailing Address - City:WELDONA
Mailing Address - State:CO
Mailing Address - Zip Code:80653
Mailing Address - Country:US
Mailing Address - Phone:970-372-7369
Mailing Address - Fax:
Practice Address - Street 1:810 FAIRGROVE CHURCH RD SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602
Practice Address - Country:US
Practice Address - Phone:828-326-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0186827367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
2610603Medicare ID - Type Unspecified