Individual provider Active NPI

Shannon Lynn Brooks, APRN

  • Family Nurse Practitioner
  • Louisville, KY
National Provider Identifier
1639787245
Registry record updated Jul 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
3014491 Issued in KY
Practice address
170 Dr Arla Way Ste 101
Louisville, KY 40229-5427
Phone
(502) 955-8480
NPI assigned
Jul 20, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X KY19765 KY
Family Nurse Practitioner 363LF0000X APRN.CNP.0042420 OH
Family Nurse Practitioner 363LF0000X 3014491 KY Primary

Addresses

Primary practice location

170 Dr Arla Way Ste 101
Louisville, KY 40229-5427

Mailing address

314 Braeburn Dr
Brooks, KY 40109-5074

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, TX, KY, MA, CA, CT6 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 6

Enrollment IDStateProvider typePAC IDDetails
I20210329000814 MI Practitioner - Nurse Practitioner 7012324650 Reassigns benefits to 1 organization
I20210903000019 TX Practitioner - Nurse Practitioner 7012324650 Reassigns benefits to 1 organization
I20211213002784 KY Practitioner - Nurse Practitioner 7012324650 Reassigns benefits to 1 organization
I20230314002764 MA Practitioner - Nurse Practitioner 7012324650 Reassigns benefits to 1 organization
I20250429003660 CA Practitioner - Nurse Practitioner 7012324650 Reassigns benefits to 2 organizations
I20250917004437 CT Practitioner - Nurse Practitioner 7012324650 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

200 Oceangate
Suite 100
Long Beach, CA 90802-4316

200 Oceangate
Suite 100
Long Beach, CA 90802-4317

314 Braeburn Dr
Brooks, KY 40109-5074

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
KY19765KYMDFamily Medicine Physician
3014491KYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Molina Care Connections, LLC. CurrentSince Mar 24, 2021 Accepting new patients
Central Health Plan of California, Inc. CurrentSince Apr 9, 2025 Accepting new patients
Molina Healthcare of California CurrentSince Apr 9, 2025 Accepting new patients

Locations

200 Oceangate
Ste 100
Long Beach, CA 90802
Phone (562) 435-3666

175 Scott Swamp Rd
Farmington, CT 06032
Phone (860) 249-6752

5100 Commerce Crossings Dr
Louisville, KY 40229
Phone (502) 305-6267

1075 Main St
Fl 4
Waltham, MA 02451

880 W Long Lake Rd
Troy, MI 48098
Phone (248) 227-6316

3000 Corporate Exchange Dr
Columbus, OH 43231
Phone (614) 942-3042

5605 N MacArthur Blvd
Ste 400
Irving, TX 75038
Phone (972) 536-7265

1660 Westridge Cir N
Irving, TX 75038
Phone (214) 467-9787

Interoperability endpoints

  • Direct secure messaging: sbrooks12259@direct-prd.molinahealthcare.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1595203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783468800000",
    "number": "1639787245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 BRAEBURN DR",
            "city": "BROOKS",
            "state": "KY",
            "postal_code": "401095074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 DR ARLA WAY STE 101",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402295427",
            "telephone_number": "502-955-8480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "SHANNON",
        "middle_name": "LYNN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-20",
        "last_updated": "2026-07-08",
        "certification_date": "2026-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "KY19765",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.0042420",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3014491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.