Provider Demographics
NPI:1154786101
Name:ELLIOTT LOWRY, BROOKE D (APRN)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:D
Last Name:ELLIOTT LOWRY
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:D
Other - Last Name:FARIA DA CUNHA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:1500 SW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1301
Mailing Address - Country:US
Mailing Address - Phone:785-354-5598
Mailing Address - Fax:785-354-5396
Practice Address - Street 1:1500 SW 10TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1301
Practice Address - Country:US
Practice Address - Phone:785-354-5598
Practice Address - Fax:785-354-5396
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS77142363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068002364OtherMEDICARE PTAN
KS201130310AMedicaid