Provider Demographics
NPI:1619184934
Name:PETERSON, BROOKE K (PMHNP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:K
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E NORTHFIELD DR
Mailing Address - Street 2:STE F, #293
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112
Mailing Address - Country:US
Mailing Address - Phone:317-649-2814
Mailing Address - Fax:828-374-1540
Practice Address - Street 1:7230 ARBUCKLE COMMONS STE 243
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112
Practice Address - Country:US
Practice Address - Phone:317-649-2814
Practice Address - Fax:828-374-1540
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28164171A163WP0809X
IN71006558A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult