Basic Information
| Provider Information | |||||||||
| NPI: | 1043805575 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROOKS | ||||||||
| FirstName: | KELLI | ||||||||
| MiddleName: | BROOKE | ||||||||
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| Credential: | MSN, NNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 PINECREST DR | ||||||||
| Address2: | |||||||||
| City: | SILSBEE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 776566209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4096730506 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2830 CALDER ST | ||||||||
| Address2: | |||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777021809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098927171 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2021 | ||||||||
| LastUpdateDate: | 03/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | 1031599 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
No ID Information.