Provider Demographics
NPI:1013668086
Name:BROOKS, AUSTIN NICHOLAS (PA)
Entity type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:NICHOLAS
Last Name:BROOKS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 HOLLY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-4426
Mailing Address - Country:US
Mailing Address - Phone:865-585-0863
Mailing Address - Fax:
Practice Address - Street 1:103 KEYSTONE DR STE 5
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-7988
Practice Address - Country:US
Practice Address - Phone:859-353-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2836363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant