Provider Demographics
NPI:1033576046
Name:KERN, BROOKE ELIZABETH (MSN, PMHNP-BC,AGNP-C)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ELIZABETH
Last Name:KERN
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC,AGNP-C
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:HENSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4240 PARK GLEN RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5427
Mailing Address - Country:US
Mailing Address - Phone:612-925-6033
Mailing Address - Fax:612-925-8496
Practice Address - Street 1:14800 GALAXIE AVE STE 305
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4530
Practice Address - Country:US
Practice Address - Phone:952-432-1484
Practice Address - Fax:952-432-2328
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 199769-1163W00000X
MN4378363LA2200X, 363LP0808X, 363LG0600X
MNCNP 4378363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty