Provider Demographics
NPI:1346729456
Name:BROOKS, KAYTI DANIELLE (LPN)
Entity type:Individual
Prefix:
First Name:KAYTI
Middle Name:DANIELLE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 SPENCER LOOP
Mailing Address - Street 2:
Mailing Address - City:MAYNARD
Mailing Address - State:AR
Mailing Address - Zip Code:72444-8501
Mailing Address - Country:US
Mailing Address - Phone:870-378-0962
Mailing Address - Fax:
Practice Address - Street 1:551 SPENCER LOOP
Practice Address - Street 2:
Practice Address - City:MAYNARD
Practice Address - State:AR
Practice Address - Zip Code:72444-8501
Practice Address - Country:US
Practice Address - Phone:870-378-0962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL059973164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse