Basic Information
| Provider Information | |||||||||
| NPI: | 1225775414 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROOKS | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2319 PIMPERNEL RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282139279 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049050172 | ||||||||
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| Practice Location | |||||||||
| Address1: | 237 TRYON RD | ||||||||
| Address2: | |||||||||
| City: | RUTHERFORDTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281393058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282867200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2022 | ||||||||
| LastUpdateDate: | 10/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | BROO-6G65J | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QA0505X | 00000000000000000000 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 363LF0000X | BROO-6G65J | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.