Provider Demographics
NPI:1447400775
Name:BROOKS, KEVIN (PA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:148 LONDON MOUNTAIN VIEW DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-6617
Mailing Address - Country:US
Mailing Address - Phone:606-877-2850
Mailing Address - Fax:606-877-2857
Practice Address - Street 1:272 LONDON MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-6601
Practice Address - Country:US
Practice Address - Phone:606-877-2850
Practice Address - Fax:606-877-2857
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1143363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYS60507OtherCHI
KY000000592078OtherANTHEM
KY7100112880Medicaid
KYPA1143OtherKY LICENSE
KYPA1143OtherKY LICENSE