MEDICARE: PATRICIA BROOKS NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP135748	TX

General Provider Information

NPI Number	:	1972016400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA BROOKS NP

Provider Business Mailing Address
First Line	:	1209 REESE WAY
Second Line	:
City	:	LANTANA
State	:	TX
Zip	:	76226-5560
Country	:	US
Telephone Number	:	940-594-8822
Fax Number	:

Provider Business Practice Location Address
First Line	:	2820 VILLAGE PKWY STE 620
Second Line	:
City	:	HIGHLAND VILLAGE
State	:	TX
Zip	:	75077-3298
Country	:	US
Telephone Number	:	972-317-2082
Fax Number	:

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

Provider Enumeration Date	:	11/07/2017
Last Update Date	:	06/09/2019

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