Healthcare Provider Details

I. General information

NPI: 1417953548
Provider Name (Legal Business Name): LAURA KNIGHT BROOKS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W PENNSYLVANIA AVE
BESSEMER CITY NC
28016-2635
US

IV. Provider business mailing address

991 W HUDSON BLVD
GASTONIA NC
28052-6430
US

V. Phone/Fax

Practice location:
  • Phone: 704-629-3465
  • Fax: 704-629-1355
Mailing address:
  • Phone: 704-853-5294
  • Fax: 704-862-5383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001000049
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: