Provider Demographics
NPI:1306518014
Name:BOST, BROOKE ANDERSON (PA-C)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANDERSON
Last Name:BOST
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 1:932 AIRPORT RHODHISS RD
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-7101
Mailing Address - Country:US
Mailing Address - Phone:828-850-7859
Mailing Address - Fax:
Practice Address - Street 1:270 PINE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NC
Practice Address - Zip Code:28638-2605
Practice Address - Country:US
Practice Address - Phone:828-757-8206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11433207RS0012X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine