Provider Demographics
NPI:1063393312
Name:HORNBERGER, BROOKE JANAY (PA-C)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:JANAY
Last Name:HORNBERGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SUMMER DR
Mailing Address - Street 2:
Mailing Address - City:PINEDALE
Mailing Address - State:WY
Mailing Address - Zip Code:82941-7902
Mailing Address - Country:US
Mailing Address - Phone:307-231-2594
Mailing Address - Fax:
Practice Address - Street 1:705 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:MO
Practice Address - Zip Code:64402-1433
Practice Address - Country:US
Practice Address - Phone:660-726-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025037859363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant