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General NPI Number Information
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NPI Number | 1952825663
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Entity Type | Individual
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Provider Name | JESSICA BROOKS
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Gender | Female
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Dates
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Enumeration Date | 08/03/2017
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 140 SPAUGY HOLLOW RD
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City | CONNELLSVILLE
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State | PA
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Zip | 15425-6518
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Country | US
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Telephone | 724-963-7083
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Fax |
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Provider Business Mailing Address
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Address Line | 140 SPAUGY HOLLOW RD
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City | CONNELLSVILLE
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State | PA
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Zip | 15425-6518
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Country | US
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Telephone |
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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 | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 1992372403
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 1043889967
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 1992372403
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F06171944
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License Number State | PA
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