Provider Demographics
NPI:1497168041
Name:JONES, BROOKE MARIE (APRN-C)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:MISS
Other - First Name:BROOKE
Other - Middle Name:MARIE
Other - Last Name:MCGOVERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-C
Mailing Address - Street 1:12256 STATE LINE RD.
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209
Mailing Address - Country:US
Mailing Address - Phone:913-345-9888
Mailing Address - Fax:913-345-0958
Practice Address - Street 1:12256 STATE LINE RD.
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209
Practice Address - Country:US
Practice Address - Phone:913-345-9888
Practice Address - Fax:913-345-0958
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5376259101363LF0000X
KS13-111661-101163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA3281001OtherMEDICARE PTAN