Active NPI
Kenneth Brooks
- Physician Assistant
- Fort Campbell, KY
National Provider Identifier
1770630261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1030465
- Practice address
- Blanchfield Army Community Hospital
650 Joel Drive
Fort Campbell, KY 42223-5349 - Phone
- (270) 798-8727
- Fax
- (270) 956-0180
- NPI assigned
- Jan 5, 2007
- 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 | 1030465 | NE | Primary |
Addresses
Primary practice location
Blanchfield Army Community Hospital
650 Joel Drive
Fort Campbell, KY 42223-5349
Mailing address
Blanchfield Army Community Hospital
650 Joel Drive
Fort Campbell, KY 42223-5349
Phone (270) 798-8727
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1030465 | NE | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242086400000",
"number": "1770630261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "BLANCHFIELD ARMY COMMUNITY HOSPITAL",
"address_2": "650 JOEL DRIVE",
"city": "FORT CAMPBELL",
"state": "KY",
"postal_code": "422235349",
"telephone_number": "270-798-8727",
"fax_number": "270-956-0180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "BLANCHFIELD ARMY COMMUNITY HOSPITAL",
"address_2": "650 JOEL DRIVE",
"city": "FORT CAMPBELL",
"state": "KY",
"postal_code": "422235349",
"telephone_number": "270-798-8727",
"fax_number": "270-956-0180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROOKS",
"first_name": "KENNETH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-05",
"last_updated": "2009-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NE",
"license": "1030465",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Campbell, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.