Provider Demographics
NPI:1619929742
Name:BRINKLEY, JOSEPH CHRISTOPHER (NP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CHRISTOPHER
Last Name:BRINKLEY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 STELLHORN RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-4631
Mailing Address - Country:US
Mailing Address - Phone:317-387-3050
Mailing Address - Fax:317-295-7044
Practice Address - Street 1:5645 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-1011
Practice Address - Country:US
Practice Address - Phone:317-387-3050
Practice Address - Fax:317-295-7044
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001274A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P59121Medicare UPIN
IN202060BMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER