Provider Demographics
NPI:1053543660
Name:STONE, BROOKNEY R (FNP)
Entity type:Individual
Prefix:
First Name:BROOKNEY
Middle Name:R
Last Name:STONE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-0336
Mailing Address - Country:US
Mailing Address - Phone:208-639-3990
Mailing Address - Fax:208-639-3992
Practice Address - Street 1:790 W USTICK RD
Practice Address - Street 2:STE 110
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5558
Practice Address - Country:US
Practice Address - Phone:208-639-3990
Practice Address - Fax:208-639-3992
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-923A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily