Brooke Davis Benincosa

Primary specialty

General Practice Registered NurseTaxonomy code 163WG0000X

License

8145482-3102 Issued in UT

Practice address

2891 Evergreen Park Dr
Huntsville, UT 84317-9686

Phone

(801) 497-1872

NPI assigned

Oct 11, 2022

Last updated

Oct 11, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1665446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665446400000",
    "number": "1194440180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2891 EVERGREEN PARK DR",
            "city": "HUNTSVILLE",
            "state": "UT",
            "postal_code": "843179686",
            "telephone_number": "801-497-1872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2891 EVERGREEN PARK DR",
            "city": "HUNTSVILLE",
            "state": "UT",
            "postal_code": "843179686",
            "telephone_number": "801-497-1872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENINCOSA",
        "first_name": "BROOKE",
        "middle_name": "DAVIS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-11",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "UT",
            "license": "8145482-3102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8014971872",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.brookebenincosa.com",
            "affiliation": "N",
            "endpointDescription": "direct messaging",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2891 Evergreen Park Dr",
            "city": "Huntsville",
            "state": "UT",
            "country_code": "US",
            "postal_code": "843179686",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• General Practice Registered Nurse in Huntsville, UT
• Providers in Huntsville, UT by specialty
• General Practice Registered Nurse in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.