Healthcare Provider Details

I. General information

NPI: 1649318627
Provider Name (Legal Business Name): REBECCA E BROOKS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5617 WINDSONG DR
JONESBORO AR
72404-8859
US

IV. Provider business mailing address

5617 WINDSONG DR
JONESBORO AR
72404-8859
US

V. Phone/Fax

Practice location:
  • Phone: 870-932-3600
  • Fax: 870-932-3611
Mailing address:
  • Phone: 870-932-3600
  • Fax: 870-932-3611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberR65448
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: