MEDICARE: DOMINIQUE A BRINKLEY LLC

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	164W00000X	Licensed Practical Nurse

General Provider Information

NPI Number	:	1154266625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOMINIQUE A BRINKLEY LLC

Provider Business Mailing Address
First Line	:	2005 SYLVIA ST
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-6124
Country	:	US
Telephone Number	:	843-804-1452
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 SYLVIA ST
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-6124
Country	:	US
Telephone Number	:	843-804-1452
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DOMINIQUE BRINKLEY
Credential	:	LICENSED NURSE
Telephone Number	:	843-804-1452

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	04/21/2026

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