Provider Demographics
NPI:1952717274
Name:HUNTER, BROOK CHANNELLE (AGACNP)
Entity type:Individual
Prefix:
First Name:BROOK
Middle Name:CHANNELLE
Last Name:HUNTER
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:CARDIOVASCULAR INTENSIVE CARE UNIT
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-815-1575
Mailing Address - Fax:601-815-1577
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:CARDIOVASCULAR INTENSIVE CARE UNIT
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-815-1575
Practice Address - Fax:601-815-1577
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR880244363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP01620203OtherRAILROAD MEDICARE
MS02739555Medicaid
MS360618YS8TMedicare PIN