Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 604324 | TX |
N | 363LP2300X | Nurse Practitioner - Primary Care | 604324 | TX |
NPI | 1063469559 |
---|---|
Provider Name | Vicki D Brooks |
First Address | Mineral Wells, TX 76067-8249 |
Second Address | Mineral Wells, TX 76067-8249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 24/03/2016 |