Provider Demographics
NPI:1215791165
Name:BROOKS, JAYONNA KA'ASIA
Entity type:Individual
Prefix:
First Name:JAYONNA
Middle Name:KA'ASIA
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8131
Mailing Address - Country:US
Mailing Address - Phone:423-209-5440
Mailing Address - Fax:423-498-4583
Practice Address - Street 1:5520 HIGH ST
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-8131
Practice Address - Country:US
Practice Address - Phone:423-209-5440
Practice Address - Fax:423-498-4583
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN272101163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health