Healthcare Provider Details

I. General information

NPI: 1689407538
Provider Name (Legal Business Name): RACHELLE LATRICE BROOKS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHELLE LATRICE HALL

II. Dates (important events)

Enumeration Date: 08/24/2024
Last Update Date: 10/10/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 NEW BYHALIA RD
COLLIERVILLE TN
38017-3716
US

IV. Provider business mailing address

PO BOX 932958
CLEVELAND OH
44193-0028
US

V. Phone/Fax

Practice location:
  • Phone: 901-853-1330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number36964
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number278193
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2359082
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61037051
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number902777
License Number StateMS
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2020035389
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: