Healthcare Provider Details

I. General information

NPI: 1174397822
Provider Name (Legal Business Name): MS. LACASTA D BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6790 STARKENBURG LN
MEMPHIS TN
38115-5308
US

IV. Provider business mailing address

6790 STARKENBURG LN
MEMPHIS TN
38115-5308
US

V. Phone/Fax

Practice location:
  • Phone: 901-237-6258
  • Fax:
Mailing address:
  • Phone: 901-237-6258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: