Provider Demographics
NPI:1427617380
Name:KENON, BROOKE (NP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:KENON
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EMBARCADERO CTR STE 1900
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:415-252-7176
Practice Address - Street 1:1 EMBARCADERO CTR STE 1900
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-3723
Practice Address - Country:US
Practice Address - Phone:415-658-6791
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61567563363L00000X
NC5019860363L00000X
TX1153271363L00000X
AZ307859363L00000X
COC-APN.0101559-C-NP363L00000X
GARN254472363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner