Individual
MR. KEVIN BROOKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
272 LONDON MOUNTAIN VIEW DR, LONDON, KY 40741-6601
(606) 877-2850
(606) 877-2857
Mailing address
148 LONDON MOUNTAIN VIEW DR, SUITE 3, LONDON, KY 40741-6617
(606) 877-2850
(606) 877-2857
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1143
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000592078
ANTHEM
KY
05
—
7100112880
—
KY
01
—
PA1143
KY LICENSE
KY
01
—
S60507
CHI
KY
Enumeration date
09/23/2008
Last updated
09/17/2019
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