Provider Demographics
NPI:1558026377
Name:BROOKER, DAKOTA BENJAMIN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAKOTA
Middle Name:BENJAMIN
Last Name:BROOKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6826
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0921
Mailing Address - Country:US
Mailing Address - Phone:740-633-4765
Mailing Address - Fax:
Practice Address - Street 1:3000 GUERNSEY ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:OH
Practice Address - Zip Code:43906-1540
Practice Address - Country:US
Practice Address - Phone:740-633-4765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2022-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2562363A00000X
OH50.007121RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant