Provider Demographics
NPI:1568405017
Name:BROOKS-HORRAR, KRISTA (MD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:BROOKS-HORRAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:N
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1310 24TH AVE S
Mailing Address - Street 2:DEPARTMENT OF NEUROLOGY
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2637
Mailing Address - Country:US
Mailing Address - Phone:615-873-7510
Mailing Address - Fax:615-873-8981
Practice Address - Street 1:1310 24TH AVE S
Practice Address - Street 2:DEPARTMENT OF NEUROLOGY
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2637
Practice Address - Country:US
Practice Address - Phone:615-873-7510
Practice Address - Fax:615-873-8981
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY367032084N0400X
TN305752084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64043631Medicaid
KY0725702Medicare PIN
KY64043631Medicaid