Healthcare Provider Details

I. General information

NPI: 1104649771
Provider Name (Legal Business Name): BROOKS HUTTON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 1/2 N MAIN ST STE 222
CONROE TX
77301-3379
US

IV. Provider business mailing address

336 1/2 N MAIN ST STE 222
CONROE TX
77301-3379
US

V. Phone/Fax

Practice location:
  • Phone: 281-729-4414
  • Fax: 281-942-1220
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1120453
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1120453
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: