Healthcare Provider Details

I. General information

NPI: 1396334637
Provider Name (Legal Business Name): DOMINIKA EUREKA BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date: 01/15/2021
Reactivation Date: 12/31/2025

III. Provider practice location address

1248 W KEISER AVE
OSCEOLA AR
72370-2917
US

IV. Provider business mailing address

4196 HIGHWAY 62 412 STE A
HARDY AR
72542-8002
US

V. Phone/Fax

Practice location:
  • Phone: 870-822-4401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number239507
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: