MEDICARE: BETHANY BROOKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	215639	AK
2	363L00000X	Nurse Practitioner	CP003604	SD

General Provider Information

NPI Number	:	1144093790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY BROOKS

Provider Business Mailing Address
First Line	:	PO BOX 5074
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57117-5074
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4405 E 26TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57103-4136
Country	:	US
Telephone Number	:	605-332-2883
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2023
Last Update Date	:	06/11/2026

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Directions to “ BETHANY BROOKS ” Practice Location

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