MEDICARE: KEBRINA BROOKS LPN

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	30002709	LA

General Provider Information

NPI Number	:	1437967221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEBRINA BROOKS LPN

Provider Business Mailing Address
First Line	:	3801 CHRISWOOD LN
Second Line	:
City	:	HARVEY
State	:	LA
Zip	:	70058-2006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4780 I 55 N STE 116
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39211-6067
Country	:	US
Telephone Number	:	504-509-0924
Fax Number	:

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

Provider Enumeration Date	:	12/25/2024
Last Update Date	:	12/25/2024

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Directions to “ KEBRINA BROOKS LPN” Practice Location

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