DR. JENNIFER ELAINE BROCKMAN


Address: 321 W Promenade St, Mexico, MO 65265-2719
Phone: 5735821234

DR. JENNIFER ELAINE BROCKMAN (NPI# 1346323870) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1346323870
Entity Type Individual
Full Name DR. JENNIFER ELAINE BROCKMAN
Credential M.D.
Practice Address 321 W Promenade St
Mexico
MO 65265-2719
Mailing Address Po Box 8525
Saint Louis
MO 63126-0525
Practice Telephone 5735821234
Practice Fax Number 5735821212
Mailing Telephone 3148437500
Mailing Fax Number 3148437503
Enumeration Date 2006-10-20
Last Update Date 2011-08-23
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 2084F0202X Psychiatry & Neurology
Specialization: Forensic Psychiatry
A96005 CA Allopathic & Osteopathic Physicians
Y 2084F0202X Psychiatry & Neurology
Specialization: Forensic Psychiatry
2004003502 MO Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
CA STATE LICENSE A96005 01
DEA NUMBER BB8794073 01
MO MISSOURI STATE LICENSE 2004003502 01

Office Location

Street Address 321 W PROMENADE ST
City MEXICO
State MO
Zip Code 65265-2719

Providers in the same location

NPI Name Taxonomy Address Enumeration
1154327641 Virginia J Caputy Social Worker 321 W Promenade St, Mexico, MO 65265 2005-06-21
1023388626 Mary D Crews Counselor 321 W Promenade St, Mexico, MO 65265-2719 2012-01-12
1073818746 Paula Reecht Social Worker 321 W Promenade St, Mexico, MO 65265-2719 2011-01-11
1649441452 Alicia Marie Reichert Counselor 321 W Promenade St, Mexico, MO 65265-2719 2008-03-19
1477731545 John H Payne Social Worker 321 W Promenade St, Mexico, MO 65265-2719 2008-01-31
1033268768 Erma Johnmeyer-schutte Nurse Practitioner 321 W Promenade St, Mexico, MO 65265-2719 2007-01-10
1003970849 Ahsan Syed Psychiatry & Neurology 321 W Promenade St, Mexico, MO 65265-2719 2006-12-19
1083791792 Sarmistha Bhalla Psychiatry & Neurology 321 W Promenade St, Mexico, MO 65265-2719 2006-11-01
1316995533 Michael Hayes Gordon Social Worker 321 W Promenade St, Mexico, MO 65265-2719 2006-05-04
1841296977 Robert Charles Berger Social Worker 321 W Promenade St, Mexico, MO 65265-2719 2005-06-23
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1700448685 Joanna Zidick Mcclarey Specialist/Technologist Rehabilitation Services, 711 E Jackson, Mexico, MO 65265 2019-07-01
1053858050 Glenna Wilson Social Worker 2462 Southern Hls, Mexico, MO 65265 2017-01-27
1457601759 Bruce Warren Garrett Dentist 626 Summit, Mexico, MO 65265 2012-09-13
1063775997 Brandon Jay Glasgow Physical Therapist 2759 A S Clark, Mexico, MO 65265 2012-06-15
1407044548 Missouri Central Physical Therapy, LLC Specialist 2759 A South Clark, Mexico, MO 65265 2007-10-12
1194925628 Curators of The University of Missouri Orthopaedic Surgery 515 East Promenade, Mexico, MO 65265 2007-07-23
1740496199 Scott Simmons Family Medicine 1000 Webster Street, Mexico, MO 65265 2007-05-15
1083741664 Finck & Associates, Inc. Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 17079 Audrain County Road 929, Mexico, MO 65265 2007-02-28
1417005893 Matthew Eugene Hart Emergency Medicine 620 E Monroe Street, Mexico, MO 65265 2007-01-08
1144392051 Corrine M Floyd Massage Therapist 713 East Jackson, Mexico, MO 65265 2006-11-15
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Taxonomy Information

Taxonomy Code 2084F0202X
Grouping Allopathic & Osteopathic Physicians
Classification Psychiatry & Neurology
Specialization Forensic Psychiatry

Taxonomy Definition

Forensic Psychiatry is a subspecialty with psychiatric focus on interrelationships with civil, criminal and administrative law, evaluation and specialized treatment of individuals involved with the legal system, incarcerated in jails, prisons, and forensic psychiatry hospitals.
Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition]

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1528581683 Elias Ghossoub Psychiatry & Neurology 1438 S Grand Blvd Rm 7, Saint Louis, MO 63104-1027 2017-07-20
1285959163 Nikita Shah Psychiatry & Neurology 1000 E 24th St Unit Office53, Kansas City, MO 64108-2776 2010-04-02
1003086638 Anasseril E Daniel Psychiatry & Neurology 33 E Broadway Ste 115, Columbia, MO 65203-4207 2008-03-11
1659541456 David Leo Vlach Psychiatry & Neurology 1115 E Pence Rd, Cameron, MO 64429-8804 2008-03-07
1912002155 Marcia Davenport Kent Psychiatry & Neurology 324 S Hudson St, Buckner, MO 64016 2006-09-13
1386633360 Terri Lynn Riutcel Psychiatry & Neurology 1600 S Brentwood Blvd Ste 600, Ste 600, Saint Louis, MO 63144-1334 2005-10-21
1992793145 Sadashiv Parwatikar Psychiatry & Neurology 2107 Menard St, Saint Louis, MO 63104-4140 2005-10-12
1184965667 William Searle Logan Psychiatry & Neurology 428 W 42nd St, Kansas City, MO 64111-3176 2013-03-08
1801137377 Stephen Eugene Peterson Psychiatry & Neurology 428 W 42nd St, Kansas City, MO 64111-3176 2013-03-08
1952569030 James Kenneth Wolfson Psychiatry & Neurology 1900 W Sunshine St, Us Medical Center for Federal Prisoners, Springfield, MO 65807-2240 2008-05-27
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Competitor

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City MEXICO
Zip Code 65265

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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