Provider Demographics
NPI:1689112831
Name:DAY, BROOKE ASHLEY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:ASHLEY
Last Name:DAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:BROOKE
Other - Middle Name:ASHLEY
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:P.O. BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-648-6400
Mailing Address - Fax:214-648-5461
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-648-6400
Practice Address - Fax:214-648-5461
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2779363A00000X
TXTEMPORARY363A00000X
TXPA12763363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant