=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396445888
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHANTELL MARIE BROOKS FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2023
-----------------------------------------------------
Last Update Date | 06/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8117 PRESTON RD STE 300
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75225-6347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-832-2122
-----------------------------------------------------
Fax | 888-599-4119
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1309 COFFEEN AVE STE 1200
-----------------------------------------------------
City | SHERIDAN
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82801-5777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-832-2122
-----------------------------------------------------
Fax | 888-599-4119
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 95022601
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------