Active NPI
Alan Lee Brokenicky, PA
- Physician Assistant
- Tulsa, OK
National Provider Identifier
1184889768
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1752
- Practice address
- 9912 E 21St St
Tulsa, OK 74129-1620 - Phone
- (918) 622-0641
- NPI assigned
- Jul 23, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1752 | OK | Primary |
Addresses
Primary practice location
9912 E 21St St
Tulsa, OK 74129-1620
Mailing address
1705 E 19TH St
Ste 302
Tulsa, OK 74104-5410
Phone (918) 748-7585
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1752 | OK | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. John Physicians, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Internal Medicine Physician
- Tulsa, OK
- NPI 1336194406
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484179200000",
"number": "1184889768",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1705 E 19TH ST",
"address_2": "STE 302",
"city": "TULSA",
"state": "OK",
"postal_code": "741045410",
"telephone_number": "918-748-7585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9912 E 21ST ST",
"city": "TULSA",
"state": "OK",
"postal_code": "741291620",
"telephone_number": "918-622-0641"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROKENICKY",
"first_name": "ALAN",
"middle_name": "LEE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-07-23",
"last_updated": "2017-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OK",
"license": "1752",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tulsa, OK
- Michelle Denise Brogdon
- Molly Megan Brogdon, APRN
- Broken Arrow Medical Group LLC
- Broken Arrow Medical LLC
- Broken Arrow Orthopedics Inc
- Bailee Bronson
- Sierra Brood
- Bruce Kimball Brookby, M.D.
- Brookdale Senior Living Communities, Inc. (Sterling House of Tulsa South)
- Brookdale Senior Living Communities, Inc. (Sterling House of Tulsa)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.