Brooke Fanning, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50.009209RX Issued in OH

Practice address

830 W High St Ste 360
Lima, OH 45801-3985

Phone

(419) 227-7117

NPI assigned

Sep 18, 2024

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 names 1

• Brooke Kimball Former name

Medicare fee-for-service enrollment

Enrolled in OH

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Mercy Health Physicians Lima Specialty Care LLC

  • Surgery Physician
  • Lima, OH
  • NPI 1518589803

  Physician Assistant

  Medicare reassignment NPD
• Mercy Emergency Care Services, Inc.

  • Emergency Medicine Physician
  • Toledo, OH
  • NPI 1477957819
  Medicare reassignment

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

{
    "created_epoch": "1726617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770336000000",
    "number": "1891522371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 W HIGH ST STE 360",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458013985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 W HIGH ST STE 360",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458013985",
            "telephone_number": "419-227-7117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANNING",
        "first_name": "BROOKE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-18",
        "last_updated": "2026-02-06",
        "certification_date": "2026-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.009209RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BROOKE",
            "last_name": "KIMBALL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Family Physicians of Lima Inc
• Family Resource Center
• Family Resource Center of Northwest Ohio Inc
• Family Resource Center of Northwest Ohio Inc
• Family Resource Center of Northwest Ohio Inc
• Samantha Farler, LISW
• Ashley N Farrar
• Kristin Farrell
• Taylor Lynn Farrier
• Ireland Makenna Fay

• Physician Assistant in Lima, OH
• Providers in Lima, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2026; 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.