Healthcare Provider Details

I. General information

NPI: 1487742953
Provider Name (Legal Business Name): KATHY BROOKS-ROCK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 MAIN STREET
CANAAN ME
04929
US

IV. Provider business mailing address

118 MOOSEHEAD TRL SUITE 5
NEWPORT ME
04953-4020
US

V. Phone/Fax

Practice location:
  • Phone: 207-414-6990
  • Fax: 207-474-8899
Mailing address:
  • Phone: 207-368-4213
  • Fax: 207-355-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR026591
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: