Healthcare Provider Details

I. General information

NPI: 1336734904
Provider Name (Legal Business Name): HEATHER DAWN BROOKS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 VENABLE LN STE 200
MONROE LA
71203-2028
US

IV. Provider business mailing address

PO BOX 9178
RUSSELLVILLE AR
72811-9178
US

V. Phone/Fax

Practice location:
  • Phone: 501-492-0092
  • Fax: 479-968-1673
Mailing address:
  • Phone: 855-498-6767
  • Fax: 479-968-1673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number648930
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number223745
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: