MEDICARE: BROOKE E MACDONALD NP

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	363LF0000X	Family Nurse Practitioner	908110	MS

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	:	1972460152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE E MACDONALD NP

Provider Business Mailing Address
First Line	:	PO BOX 649113
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75264-9113
Country	:	US
Telephone Number	:	601-545-7021
Fax Number	:	601-545-6978

Provider Business Practice Location Address
First Line	:	7100 U S HIGHWAY 98 STE 210
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-8557
Country	:	US
Telephone Number	:	601-545-7021
Fax Number	:	601-545-6978

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

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	04/21/2026

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