DR. JENNIFER ELAINE BROCKMAN (NPI# 1346323870) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1346323870 |
Entity Type | Individual |
Full Name | DR. JENNIFER ELAINE BROCKMAN |
Credential | M.D. |
Practice Address |
321 W Promenade St Mexico MO 65265-2719 |
Mailing Address |
Po Box 8525 Saint Louis MO 63126-0525 |
Practice Telephone | 5735821234 |
Practice Fax Number | 5735821212 |
Mailing Telephone | 3148437500 |
Mailing Fax Number | 3148437503 |
Enumeration Date | 2006-10-20 |
Last Update Date | 2011-08-23 |
Gender Code | F |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 2084F0202X |
Psychiatry & Neurology Specialization: Forensic Psychiatry |
A96005 | CA | Allopathic & Osteopathic Physicians |
Y | 2084F0202X |
Psychiatry & Neurology Specialization: Forensic Psychiatry |
2004003502 | MO | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
CA | STATE LICENSE | A96005 | 01 |
DEA NUMBER | BB8794073 | 01 | |
MO | MISSOURI STATE LICENSE | 2004003502 | 01 |
Street Address |
321 W PROMENADE ST |
City | MEXICO |
State | MO |
Zip Code | 65265-2719 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1154327641 | Virginia J Caputy | Social Worker | 321 W Promenade St, Mexico, MO 65265 | 2005-06-21 |
1023388626 | Mary D Crews | Counselor | 321 W Promenade St, Mexico, MO 65265-2719 | 2012-01-12 |
1073818746 | Paula Reecht | Social Worker | 321 W Promenade St, Mexico, MO 65265-2719 | 2011-01-11 |
1649441452 | Alicia Marie Reichert | Counselor | 321 W Promenade St, Mexico, MO 65265-2719 | 2008-03-19 |
1477731545 | John H Payne | Social Worker | 321 W Promenade St, Mexico, MO 65265-2719 | 2008-01-31 |
1033268768 | Erma Johnmeyer-schutte | Nurse Practitioner | 321 W Promenade St, Mexico, MO 65265-2719 | 2007-01-10 |
1003970849 | Ahsan Syed | Psychiatry & Neurology | 321 W Promenade St, Mexico, MO 65265-2719 | 2006-12-19 |
1083791792 | Sarmistha Bhalla | Psychiatry & Neurology | 321 W Promenade St, Mexico, MO 65265-2719 | 2006-11-01 |
1316995533 | Michael Hayes Gordon | Social Worker | 321 W Promenade St, Mexico, MO 65265-2719 | 2006-05-04 |
1841296977 | Robert Charles Berger | Social Worker | 321 W Promenade St, Mexico, MO 65265-2719 | 2005-06-23 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1700448685 | Joanna Zidick Mcclarey | Specialist/Technologist | Rehabilitation Services, 711 E Jackson, Mexico, MO 65265 | 2019-07-01 |
1053858050 | Glenna Wilson | Social Worker | 2462 Southern Hls, Mexico, MO 65265 | 2017-01-27 |
1457601759 | Bruce Warren Garrett | Dentist | 626 Summit, Mexico, MO 65265 | 2012-09-13 |
1063775997 | Brandon Jay Glasgow | Physical Therapist | 2759 A S Clark, Mexico, MO 65265 | 2012-06-15 |
1407044548 | Missouri Central Physical Therapy, LLC | Specialist | 2759 A South Clark, Mexico, MO 65265 | 2007-10-12 |
1194925628 | Curators of The University of Missouri | Orthopaedic Surgery | 515 East Promenade, Mexico, MO 65265 | 2007-07-23 |
1740496199 | Scott Simmons | Family Medicine | 1000 Webster Street, Mexico, MO 65265 | 2007-05-15 |
1083741664 | Finck & Associates, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 17079 Audrain County Road 929, Mexico, MO 65265 | 2007-02-28 |
1417005893 | Matthew Eugene Hart | Emergency Medicine | 620 E Monroe Street, Mexico, MO 65265 | 2007-01-08 |
1144392051 | Corrine M Floyd | Massage Therapist | 713 East Jackson, Mexico, MO 65265 | 2006-11-15 |
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Taxonomy Code | 2084F0202X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Psychiatry & Neurology |
Specialization | Forensic Psychiatry |
Forensic Psychiatry is a subspecialty with psychiatric focus on interrelationships with civil, criminal and administrative law, evaluation and specialized treatment of individuals involved with the legal system, incarcerated in jails, prisons, and forensic psychiatry hospitals. |
Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1528581683 | Elias Ghossoub | Psychiatry & Neurology | 1438 S Grand Blvd Rm 7, Saint Louis, MO 63104-1027 | 2017-07-20 |
1285959163 | Nikita Shah | Psychiatry & Neurology | 1000 E 24th St Unit Office53, Kansas City, MO 64108-2776 | 2010-04-02 |
1003086638 | Anasseril E Daniel | Psychiatry & Neurology | 33 E Broadway Ste 115, Columbia, MO 65203-4207 | 2008-03-11 |
1659541456 | David Leo Vlach | Psychiatry & Neurology | 1115 E Pence Rd, Cameron, MO 64429-8804 | 2008-03-07 |
1912002155 | Marcia Davenport Kent | Psychiatry & Neurology | 324 S Hudson St, Buckner, MO 64016 | 2006-09-13 |
1386633360 | Terri Lynn Riutcel | Psychiatry & Neurology | 1600 S Brentwood Blvd Ste 600, Ste 600, Saint Louis, MO 63144-1334 | 2005-10-21 |
1992793145 | Sadashiv Parwatikar | Psychiatry & Neurology | 2107 Menard St, Saint Louis, MO 63104-4140 | 2005-10-12 |
1184965667 | William Searle Logan | Psychiatry & Neurology | 428 W 42nd St, Kansas City, MO 64111-3176 | 2013-03-08 |
1801137377 | Stephen Eugene Peterson | Psychiatry & Neurology | 428 W 42nd St, Kansas City, MO 64111-3176 | 2013-03-08 |
1952569030 | James Kenneth Wolfson | Psychiatry & Neurology | 1900 W Sunshine St, Us Medical Center for Federal Prisoners, Springfield, MO 65807-2240 | 2008-05-27 |
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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.