MS. BROOKE S. SOUTHERLAND (NPI# 1205123833) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205123833 |
| Entity Type | Individual |
| Full Name | MS. BROOKE S. SOUTHERLAND |
| Credential | PA-C |
| Practice Address |
1701 N Senate Avenue Rm Ag001 Indianapolis IN 46202-1239 |
| Mailing Address |
250 N Shadeland Ave Ste 130 Provider Enrollment Indianapolis IN 46219-4959 |
| Practice Telephone | 3179623886 |
| Practice Fax Number | 3179628552 |
| Enumeration Date | 2011-07-04 |
| Last Update Date | 2014-02-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 10001364A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | NY | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | ANTHEM PIN | 000000743223 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811465420 | Brooke Mckenzie Southerland | Physician Assistant | 18901 Lake Shore Blvd, Euclid, OH 44119-1078 | 2018-11-13 |
| Street Address |
1701 N SENATE AVENUE RM AG001 |
| City | INDIANAPOLIS |
| State | IN |
| Zip Code | 46202-1239 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790386886 | Sara Brooke Horn | Registered Nurse | 1801 N Senate Ave Ste 3300, Indianapolis, IN 46202 | 2020-11-04 |
| 1013521905 | Zachary Camden Grimes | Registered Nurse | 720 Eskenazi Avenute, Indianapolis, IN 46202 | 2020-09-08 |
| 1790314045 | Scott C Mitchell II | Student in an Organized Health Care Education/Training Program | Indiana University School of Medicine Dept of Neurosurg, 355 W. 16th St, Gh 5100, Indianapolis, IN 46202 | 2020-04-07 |
| 1053940676 | James Patrick Kelly Iv | Student in an Organized Health Care Education/Training Program | 705 Riley Hospital Dr., Ri-5837, Indianapolis, IN 46202 | 2020-04-06 |
| 1124657697 | Betsy Wilson Stevens | Student in an Organized Health Care Education/Training Program | 705 Riley Hospital Drive, Ri-5837, Indianapolis, IN 46202 | 2020-04-06 |
| 1093340580 | Brian T Edmonds | Social Worker | Sandra Eskenazi Mental Health Center, 1700 N Illinois St, Indianapolis, IN 46202 | 2020-03-05 |
| 1326683210 | Lindsay Nicole Rich | Nurse Practitioner | 1800 N Senate Ave, Indianapolis, IN 46202 | 2019-11-14 |
| 1427693670 | Ronald Mcdonald House Charities of Central Indiana | Voluntary or Charitable | 435 Limestone Street, Indianaplois, IN 46202 | 2019-11-12 |
| 1790344760 | Kirsten Denise Leaberry | Student in an Organized Health Care Education/Training Program | Iu Health Neuroscience Center, Goodman Hall, 355 West 16th Street, Indianapolis, IN 46202 | 2019-06-12 |
| 1679138093 | Chris Olson Jr. | Student in an Organized Health Care Education/Training Program | 1701 N. Senate Blvd, Ag012, Indianapolis, IN 46202 | 2019-05-02 |
| Find all providers in zip 46202 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639779739 | Brock Sokolowski | Physician Assistant | 4581 Nikki Dr Apt D, Indianapolis, IN 46237-1703 | 2020-10-28 |
| 1699373357 | Dillon Etter | Physician Assistant | 2848 N Delaware St, Indianapolis, IN 46205-4118 | 2020-10-15 |
| 1962017210 | Taylor Lee Bowen | Physician Assistant | 2760 Woodwind Way, Indianapolis, IN 46268-4233 | 2020-09-14 |
| 1912512476 | William Terrell Parmenter | Physician Assistant | 2230 English Ave, Indianapolis, IN 46201-4017 | 2020-09-11 |
| 1457966376 | Angela Shearon | Physician Assistant | 4325 N College Ave, Indianapolis, IN 46205-1931 | 2020-09-09 |
| 1639797004 | John Padraic Allbritton | Physician Assistant | 9339 Notre Dame Dr Apt D, Indianapolis, IN 46240-4168 | 2020-07-11 |
| 1154949907 | Jonathon Michael Hirsch | Physician Assistant | 5801 N Olney St Apt 9, Indianapolis, IN 46220-5181 | 2020-07-08 |
| 1437776838 | Megan Leanna Reynolds | Physician Assistant | 3841 Rookwood Ave, Indianapolis, IN 46208-3926 | 2020-07-01 |
| 1669099412 | Alisa Elaine Schrump | Physician Assistant | 7618 Old Hickory Ct, Indianapolis, IN 46259-9575 | 2020-06-28 |
| 1144846148 | Melanie M. Herrold | Physician Assistant | 5255 E Stop 11 Rd Ste 200, Indianapolis, IN 46237-6341 | 2020-06-25 |
| Find all providers in INDIANAPOLIS | ||||
| City | INDIANAPOLIS |
| Zip Code | 46202 |
Please comment or provide details below to improve the information on MS. BROOKE S. SOUTHERLAND.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.