Provider Demographics
NPI:1386118735
Name:BROOKS, KATHERINE (CRNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 BERKSHIRE LANE
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-5908
Mailing Address - Country:US
Mailing Address - Phone:256-840-3437
Mailing Address - Fax:
Practice Address - Street 1:1241 BLOUNT AVE
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-1831
Practice Address - Country:US
Practice Address - Phone:256-582-6377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1147057163W00000X
AL1-147057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL163W00000XOtherNONE