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General NPI Number Information
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NPI Number | 1194648253
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Entity Type | Individual
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Provider Name | MERSADEZE STAR BROOKS RN
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Gender | Female
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Dates
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Enumeration Date | 08/04/2026
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Last Update Date | 08/04/2026
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Provider Practice Location Address
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Address Line | 1814 W NETTLETON AVE
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City | JONESBORO
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State | AR
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Zip | 72401-3637
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Country | US
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Telephone | 870-933-5820
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Fax |
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Provider Business Mailing Address
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Address Line | 156 COUNTY ROAD 753
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City | JONESBORO
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State | AR
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Zip | 72405-7774
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Country | US
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Telephone | 870-761-1206
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R102383
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License Number State | AR
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