Active NPI
Brooke Christian Shriner, PHD
- Clinical Psychologist
- Louisville, KY
National Provider Identifier
1629302633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 130741
- Practice address
- 4912 US Highway 42
Suite 104
Louisville, KY 40222-6349 - Phone
- (502) 429-8640
- Fax
- (502) 426-2283
- NPI assigned
- Sep 23, 2009
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 130741 | KY | Primary |
Addresses
Primary practice location
4912 US Highway 42
Suite 104
Louisville, KY 40222-6349
Mailing address
100 E Liberty St
Suite 800
Louisville, KY 40202-1434
Phone (502) 429-8640
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100153420 | Medicaid | KY | |
| 201012380A | Medicaid | IN | |
| 300000550 (KOHMG) | Medicaid | IN | |
| 000000709956 | Other | KY | ANTHEM BC/BS |
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
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 130741 | KY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493596800000",
"number": "1629302633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 E LIBERTY ST",
"address_2": "SUITE 800",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402021434",
"telephone_number": "502-429-8640",
"fax_number": "502-426-2283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4912 US HIGHWAY 42",
"address_2": "SUITE 104",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402226349",
"telephone_number": "502-429-8640",
"fax_number": "502-426-2283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHRINER",
"first_name": "BROOKE",
"middle_name": "CHRISTIAN",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-09-23",
"last_updated": "2017-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "KY",
"license": "130741",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7100153420",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201012380A",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "300000550 (KOHMG)",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BC/BS",
"identifier": "000000709956",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 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.