MEDICARE: KATHRYN 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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1376970319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN BROOKS

Provider Business Mailing Address
First Line	:	GENERAL DELIVERY
Second Line	:
City	:	MANLEY HOT SPRINGS
State	:	AK
Zip	:	99756-9999
Country	:	US
Telephone Number	:	907-672-3333
Fax Number	:	907-672-3175

Provider Business Practice Location Address
First Line	:	GENERAL DELIVERY
Second Line	:
City	:	MANLEY HOT SPRINGS
State	:	AK
Zip	:	99756-9999
Country	:	US
Telephone Number	:	907-672-3333
Fax Number	:	907-672-3175

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

Provider Enumeration Date	:	10/04/2013
Last Update Date	:	10/04/2013

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Directions to “ KATHRYN BROOKS ” Practice Location

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