MEDICARE: LAURA KNIGHT BROOKS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	001000049	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417953548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA KNIGHT BROOKS PA-C

Provider Business Mailing Address
First Line	:	991 W HUDSON BLVD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-6430
Country	:	US
Telephone Number	:	704-853-5294
Fax Number	:	704-862-5383

Provider Business Practice Location Address
First Line	:	119 W PENNSYLVANIA AVE
Second Line	:
City	:	BESSEMER CITY
State	:	NC
Zip	:	28016-2635
Country	:	US
Telephone Number	:	704-629-3465
Fax Number	:	704-629-1355

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	02/09/2011

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