Provider Demographics
NPI:1265868301
Name:HIATT, BROOKE CAROLINE (PA)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:CAROLINE
Last Name:HIATT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:20920 W 151ST ST
Mailing Address - Street 2:100
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7247
Mailing Address - Country:US
Mailing Address - Phone:913-782-1148
Mailing Address - Fax:913-782-1097
Practice Address - Street 1:20920 W 151ST ST
Practice Address - Street 2:100
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7247
Practice Address - Country:US
Practice Address - Phone:913-782-1148
Practice Address - Fax:913-782-1097
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2018-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS15-01647363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant