Healthcare Provider Details

I. General information

NPI: 1316375439
Provider Name (Legal Business Name): KATHRYN BROOKS ND, LAC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N FIR ST SUITE 101
SISTERS OR
97759-0180
US

IV. Provider business mailing address

PO BOX 217
SISTERS OR
97759-0217
US

V. Phone/Fax

Practice location:
  • Phone: 541-200-7773
  • Fax: 855-475-8027
Mailing address:
  • Phone: 541-200-7773
  • Fax: 855-475-8027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1998
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC185430
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: