Provider Demographics
NPI:1942441423
Name:THIELKING, BROOKE E (NP-C)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:E
Last Name:THIELKING
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:E
Other - Last Name:THIELKING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2570 106TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3742
Mailing Address - Country:US
Mailing Address - Phone:515-664-9418
Mailing Address - Fax:
Practice Address - Street 1:2570 106TH ST STE E
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-3742
Practice Address - Country:US
Practice Address - Phone:515-664-9418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA110227363L00000X, 363LF0000X
KS46327363LF0000X
MO2004018377363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1942441423Medicaid
MO43341011OtherBCBS OF KANSAS CITY
MOP00708246OtherRAILROAD MEDICARE MO
MO3054094OtherUNITED HEALTHCARE
KSP00719486OtherRAILROAD MEDICARE KS
KSP00719486OtherRAILROAD MEDICARE KS
MO1942441423Medicaid
MO3054094OtherUNITED HEALTHCARE
MO43341011OtherBCBS OF KANSAS CITY