Provider Demographics
NPI:1417049404
Name:BROOKS-HALL, REGINA MARY (APRN)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:MARY
Last Name:BROOKS-HALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:REGINA
Other - Middle Name:MARY
Other - Last Name:BROOKS
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:859-301-2000
Mailing Address - Fax:859-426-4140
Practice Address - Street 1:711 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3439
Practice Address - Country:US
Practice Address - Phone:859-331-0774
Practice Address - Fax:859-578-3800
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001168260163W00000X
VA0017138054363L00000X
KY3006374363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3159844Medicaid
KY7100163060Medicaid
KY7100163060Medicaid
KYK030450Medicare PIN