Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-13-13630 | TX |
NPI | 1013349026 |
---|---|
Provider Name | Mrs. Krista Ann Brooker |
First Address | Las Cruces, NM 88005-3248 |
Second Address | Las Cruces, NM 88005-2925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2013 |
Last Update Date | 10/10/2016 |