BROOKE MCKENZIE SOUTHERLAND (NPI# 1811465420) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1811465420 |
Entity Type | Individual |
Full Name | BROOKE MCKENZIE SOUTHERLAND |
Credential | PA-C, MPAS |
Practice Address |
18901 Lake Shore Blvd Euclid OH 44119-1078 |
Mailing Address |
1990 Layton Rd Fowlerville MI 48836-8984 |
Practice Telephone | 2165319000 |
Mailing Telephone | 5176729113 |
Enumeration Date | 2018-11-13 |
Last Update Date | 2020-10-12 |
Gender Code | F |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
50.006624 | OH | Physician Assistants & Advanced Practice Nursing Providers |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1205123833 | Brooke S. Southerland | Physician Assistant | 1701 N Senate Avenue, Rm Ag001, Indianapolis, IN 46202-1239 | 2011-07-04 |
Street Address |
18901 LAKE SHORE BLVD |
City | EUCLID |
State | OH |
Zip Code | 44119-1078 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1275522930 | Sarah B Sloop | Physician Assistant | 18901 Lake Shore Blvd, Euclid, OH 44119-1078 | 2005-10-17 |
1306465430 | Katherine Arlene Regula | Music Therapist | 18901 Lake Shore Blvd, Euclid, OH 44119-1078 | 2020-04-09 |
1134758006 | Lynne L Taylor | Occupational Therapist | 18901 Lake Shore Blvd, Euclid, OH 44119-1078 | 2020-04-03 |
1861020166 | Beth Farrington | Occupational Therapist | 18901 Lake Shore Blvd, Euclid, OH 44119-1078 | 2020-03-31 |
1972131266 | Christine Loofboro | Occupational Therapist | 18901 Lake Shore Blvd, Euclid, OH 44119-1078 | 2020-03-31 |
1023646593 | David Scott Lea | Occupational Therapist | 18901 Lake Shore Blvd, Euclid, OH 44119-1078 | 2020-03-31 |
1922636489 | Kevin Mark Daykin | Occupational Therapist | 18901 Lake Shore Blvd, Euclid, OH 44119-1078 | 2020-03-31 |
1922636471 | Matthew D Burnett | Physical Therapist | 18901 Lake Shore Blvd, Euclid, OH 44119-1078 | 2020-03-31 |
1962039214 | Victoria Lane Ferry | Physical Medicine & Rehabilitation | 18901 Lake Shore Blvd, Euclid, OH 44119-1078 | 2020-03-26 |
1508490079 | Alicia Gordon | Physician Assistant | 18901 Lake Shore Blvd, Euclid, OH 44119-1078 | 2020-02-24 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1700407517 | Cornerstone Behavioral Health LLC | Counselor | 814 E 185th Street, Suite 300, Cleveland, OH 44119 | 2020-05-04 |
1194216341 | Margaret Rachelle Logan | Counselor | 17809 Neff Rd, Cleveland, OH 44119 | 2018-05-23 |
1093230526 | Brittany Martin | Registered Nurse | 1060 East 177th, Cleveland, OH 44119 | 2017-08-05 |
1881047454 | Vanessa Renee Smith | Registered Nurse | 671 E. 200th St, Euclid, OH 44119 | 2016-07-19 |
1710395264 | Lakeshore Intergenerational School | Psychologist | 18025 Marcella Rd, Cleveland, OH 44119 | 2014-07-29 |
1184967820 | Latonya Robinson | Licensed Practical Nurse | 18001 Harland Ave, Cleveland, OH 44119 | 2013-04-01 |
1396016911 | Tameika Annmarie Anderson | Registered Nurse | 20301 Lindbergh Ave., Euclid, OH 44119 | 2012-01-13 |
1871805077 | Tabitha L White | Licensed Practical Nurse | 18016 Hiller Ave, Cleveland, OH 44119 | 2010-07-06 |
1659573277 | Deborah M Barker | Physical Therapist | 18901 Lakeshore Blvd., Euclid, OH 44119 | 2007-06-05 |
1861694234 | University Primary Care Practices Inc | Podiatrist | 18599 Lake Shore Blvd Ste 600, Euclid, OH 44119 | 2007-06-05 |
Find all providers in zip 44119 |
Taxonomy Code | 363AS0400X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Surgical Technologist |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1508490079 | Alicia Gordon | Physician Assistant | 18901 Lake Shore Blvd, Euclid, OH 44119-1078 | 2020-02-24 |
1235681867 | Elise Hurtuk | Physician Assistant | 18901 Lake Shore Blvd, Euclid, OH 44119-1078 | 2016-10-31 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1508418260 | Collin Dees | Physician Assistant | Tripoint Medical Center, 7590 Auburn Road, Painesville, OH 44077 | 2019-07-12 |
1811469968 | Cody Tyler Delaney | Physician Assistant | 1711 27th St Ste 306, Portsmouth, OH 45662-2669 | 2018-12-28 |
1861936155 | Surgical Fusion, LLC | Physician Assistant | 605 N High St # 237, Columbus, OH 43215-2024 | 2016-12-06 |
1225481690 | Rebekah Keesee | Physician Assistant | 1045 Arundel Ave, Westerville, OH 43081-1188 | 2016-07-20 |
1568814382 | Kristen Cipolla | Physician Assistant | 1049 Scarlet Oak Dr Apt D, Hudson, OH 44236-4542 | 2016-07-05 |
1932560083 | Adam Peckinpaugh | Physician Assistant | 2109 Hughes Drive #450, Jobst Vascular Institute, Toledo, OH 43606-5102 | 2016-03-17 |
1710348701 | Alex Blake | Physician Assistant | 10743 S State Route 133, Blanchester, OH 45107-9435 | 2016-03-17 |
1215319926 | Richard Alan Stevenson | Physician Assistant | 187 Vine St, Fairborn, OH 45324-3324 | 2015-06-18 |
1548641038 | Matthew Hamley | Physician Assistant | 2315 Birch Trace Dr, Youngstown, OH 44515-4914 | 2015-06-10 |
1588094148 | Kevin W. Rotondo | Physician Assistant | 1732 Maple St, Wickliffe, OH 44092-2423 | 2013-11-19 |
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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.