Provider Demographics
NPI:1376208702
Name:KIRK, BROOKE ALEXANDRIA (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:ALEXANDRIA
Last Name:KIRK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 GOSPEL TABERNACLE RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:WV
Mailing Address - Zip Code:24712-9431
Mailing Address - Country:US
Mailing Address - Phone:304-952-3400
Mailing Address - Fax:
Practice Address - Street 1:150 MISTY LANE (PRINCETON FAMILY MEDICINE PLLC)
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740
Practice Address - Country:US
Practice Address - Phone:304-425-4040
Practice Address - Fax:304-425-4041
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV110289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily