Brooke Osborne Edmisten, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-00129 Issued in NC

Practice address

1126 N Church St
Suite 300
Greensboro, NC 27401-1000

Phone

(336) 547-1752

Fax

(336) 547-1858

NPI assigned

Jan 20, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571184000000",
    "number": "1811977184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1126 N CHURCH ST",
            "address_2": "SUITE 300",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011000",
            "telephone_number": "336-547-1752",
            "fax_number": "336-547-1858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1126 N CHURCH ST",
            "address_2": "SUITE 300",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011000",
            "telephone_number": "336-547-1752",
            "fax_number": "336-547-1858"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Medical Center Blvd",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271571000",
            "country_code": "US",
            "telephone_number": "336-716-2255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EDMISTEN",
        "first_name": "BROOKE",
        "middle_name": "OSBORNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-20",
        "last_updated": "2019-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-00129",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8101245",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yolanda Deonne Ector
• Ed Martinez, DDS, Ms, PA
• Kari Merrill Eddington, PH.D.
• Onoriode Sylvester Edeh, M.D
• Jenny Edminson, LCSW, LCASA
• Kristie L Edmisten, PA
• Hanna Edmiston
• John Stewart Edmunds, MD, PHD
• Morgan Edstrom
• Edward Franklyn Morris (Agape Psychological Consortium)

• Physician Assistant in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.