Healthcare Provider Details

I. General information

NPI: 1386508257
Provider Name (Legal Business Name): VANITY BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 BRICK KILN LOOP
CLAYTON NC
27520-9690
US

IV. Provider business mailing address

183 BRICK KILN LOOP
CLAYTON NC
27520-9690
US

V. Phone/Fax

Practice location:
  • Phone: 984-296-1762
  • Fax:
Mailing address:
  • Phone: 984-296-1762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number36927547
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: