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General NPI Number Information
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NPI Number | 1649051046
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Entity Type | Organization
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Legal Business Name | OLE BROOK KIDS, P.C.
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Dates
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Enumeration Date | 10/11/2023
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Last Update Date | 01/25/2026
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Provider Practice Location Address
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Address Line | 508 BROOKWAY BLVD
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City | BROOKHAVEN
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State | MS
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Zip | 39601-3267
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Country | US
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Telephone | 601-835-1062
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1403
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City | BROOKHAVEN
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State | MS
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Zip | 39602-1403
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Country | US
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Telephone | 601-757-9689
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Fax |
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER
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Name | MRS. AMBER NICOLE MARTIN
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Credential | APRN, CPNP
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Telephone | 601-757-9689
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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