Provider Demographics
NPI:1841441805
Name:KUTKA, BROOKE B (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:B
Last Name:KUTKA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7407 N CEDAR AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3839
Mailing Address - Country:US
Mailing Address - Phone:260-432-4400
Mailing Address - Fax:260-969-6898
Practice Address - Street 1:7407 N CEDAR AVE
Practice Address - Street 2:STE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3839
Practice Address - Country:US
Practice Address - Phone:559-431-4007
Practice Address - Fax:559-431-3357
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20450363AM0700X, 363A00000X
IN10001030A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical