Healthcare Provider Details

I. General information

NPI: 1659342491
Provider Name (Legal Business Name): KELLIE BROOKS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 MONARCH ROAD
ST. CHARLES VA
24282-0269
US

IV. Provider business mailing address

276 FIELDSTONE DR
JONESVILLE VA
24263-1215
US

V. Phone/Fax

Practice location:
  • Phone: 276-546-5310
  • Fax: 276-546-5469
Mailing address:
  • Phone: 276-546-5310
  • Fax: 276-546-5469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number002400043
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: