Provider Demographics
NPI:1679067631
Name:BROOKER, MATTHEW (APRN)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:BROOKER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 RAVINES EDGE CT STE 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5423
Mailing Address - Country:US
Mailing Address - Phone:888-364-5977
Mailing Address - Fax:651-348-3370
Practice Address - Street 1:8001 RAVINES EDGE CT STE 201
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-5423
Practice Address - Country:US
Practice Address - Phone:614-896-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.022920363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health