MEDICARE: BROOKE ALEXA BROOKS PA-C

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	207RG0100X	Gastroenterology Physician	MPA.3354PA	SC
2	363A00000X	Physician Assistant	3354	SC

General Provider Information

NPI Number	:	1497398721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE ALEXA BROOKS PA-C

Provider Business Mailing Address
First Line	:	1144 OAKCREST DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-9328
Country	:	US
Telephone Number	:	610-751-0374
Fax Number	:

Provider Business Practice Location Address
First Line	:	3227 WALTER DR STE 1B
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-8171
Country	:	US
Telephone Number	:	843-872-5454
Fax Number	:

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

Provider Enumeration Date	:	10/18/2019
Last Update Date	:	11/18/2020

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Directions to “ BROOKE ALEXA BROOKS PA-C” Practice Location

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