Brook Jyllaine Crist, FNP-C

Key facts

NPI

1689401002

Entity type

Individual (NPI type 1)

Primary specialty

Family Nurse Practitioner 363LF0000X

License

28193173A (IN)

Practice address

6772 W County Road 100 N
Logansport, IN 46947-7043

Phone

(574) 398-7222

NPI assigned

Sep 18, 2024

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 18, 2024.

{
    "created_epoch": "1726617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1689401002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6772 W COUNTY ROAD 100 N",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469477043",
            "telephone_number": "574-398-7222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6772 W COUNTY ROAD 100 N",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469477043",
            "telephone_number": "574-398-7222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRIST",
        "first_name": "BROOK",
        "middle_name": "JYLLAINE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-18",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "28193173A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Logansport, IN

• Brianna Lauren Barrett Cover
• Samantha Lynn Cox
• Alida Crafford, OTR
• Jennifer Lynn Craig
• Connie Sue Cripe, RN
• Jessica Crume, MSW
• Glorisel Cruz Velez
• Rafael Cruz, M.D.
• Kayci Cunningham, BSW
• Curtis Kesling

All providers in Logansport, IN · Family Nurse Practitioner in Indiana