Healthcare Provider Details

I. General information

NPI: 1093373052
Provider Name (Legal Business Name): ANNA MARIE BROOKS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 01/10/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 MAIN STREET
FULTON AL
36446
US

IV. Provider business mailing address

24B CAMDEN BYP
CAMDEN AL
36726-1770
US

V. Phone/Fax

Practice location:
  • Phone: 334-636-4823
  • Fax:
Mailing address:
  • Phone: 334-882-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-137174
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: