Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 1031599 | TX |
NPI | 1043805575 |
---|---|
Provider Name | Kelli Brooke Brooks |
First Address | Silsbee, TX 77656-6209 |
Second Address | Beaumont, TX 77702-1809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2021 |
Last Update Date | 05/03/2021 |