MEDICARE: KIWANA TRECHELLE BROOKS APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11001515	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1-103823	AL

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	:	1831656701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIWANA TRECHELLE BROOKS APRN

Provider Business Mailing Address
First Line	:	3737 GOVERNMENT BLVD STE 203
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36693-4310
Country	:	US
Telephone Number	:	251-300-7314
Fax Number	:	251-202-7851

Provider Business Practice Location Address
First Line	:	3501 GULF SHORES PKWY
Second Line	:
City	:	GULF SHORES
State	:	AL
Zip	:	36542-5710
Country	:	US
Telephone Number	:	251-300-7134
Fax Number	:

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

Provider Enumeration Date	:	02/26/2019
Last Update Date	:	06/30/2021

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Directions to “ KIWANA TRECHELLE BROOKS APRN” Practice Location

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