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General NPI Number Information
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NPI Number | 1952874620
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Entity Type | Individual
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Provider Name | KATHLEEN A BROOKS FNP
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Gender | Female
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Dates
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Enumeration Date | 01/06/2019
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 1334 SUNBURST DR
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City | O FALLON
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State | MO
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Zip | 63366-3491
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Country | US
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Telephone | 636-385-6122
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Fax | 833-033-0590
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Provider Business Mailing Address
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Address Line | 307 LAKE SIDE VIEW LN
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City | SAINT PETERS
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State | MO
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Zip | 63376-2293
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Country | US
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Telephone | 478-973-8048
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2017002506
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License Number State | MO
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