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General NPI Number Information
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NPI Number | 1043075328
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Entity Type | Individual
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Provider Name | BROOKE NICOLE REA FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/16/2024
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | 865 DESHONG DR
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City | PARIS
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State | TX
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Zip | 75460-9313
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Country | US
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Telephone | 903-737-1165
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Fax |
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Provider Business Mailing Address
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Address Line | 1060 BRAYDAN
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City | RENO
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State | TX
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Zip | 75462-5902
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Country | US
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Telephone | 903-401-0060
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1153073
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1153073
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License Number State | TX
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