Healthcare Provider Details

I. General information

NPI: 1316688641
Provider Name (Legal Business Name): BROOKLYN DEVRIES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KUMC 3901 RAINBOW BLVD MS 1034
KANSAS CITY KS
66160-0001
US

IV. Provider business mailing address

KUMC 3901 RAINBOW BLVD MS 1034
KANSAS CITY KS
66160-0001
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-3304
  • Fax: 913-588-3365
Mailing address:
  • Phone: 913-588-3304
  • Fax: 913-588-3365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA206990
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number94-10951
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: