Healthcare Provider Details

I. General information

NPI: 1487005682
Provider Name (Legal Business Name): JIMMETTE N BROOKS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 WASHINGTON ST
COVENTRY RI
02816-5476
US

IV. Provider business mailing address

595 WASHINGTON ST
COVENTRY RI
02816-5476
US

V. Phone/Fax

Practice location:
  • Phone: 401-822-2772
  • Fax: 401-821-5260
Mailing address:
  • Phone: 401-822-2772
  • Fax: 401-821-5260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD16412
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: