Provider Demographics
NPI:1447364898
Name:BROOKS, TROY DAVID (PA)
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:DAVID
Last Name:BROOKS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1348
Mailing Address - Country:US
Mailing Address - Phone:859-404-7686
Mailing Address - Fax:859-274-4312
Practice Address - Street 1:68 E ELKINS ST
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:KY
Practice Address - Zip Code:40380-2311
Practice Address - Country:US
Practice Address - Phone:606-663-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA287363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35001791Medicaid
KY000000356917OtherBLUE CROSS
KY607850200OtherFEDERAL BLACK LUNG
KY0956901Medicare ID - Type Unspecified
KY000000356917OtherBLUE CROSS