Provider Demographics
NPI:1386939288
Name:DREISS, BROOKE ELLEN (FNP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ELLEN
Last Name:DREISS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-593-8441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120298363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-0818167-044OtherTRICARE
TX75-2616977-028OtherTRICARE
TX315303302Medicaid
TX315303304Medicaid
TX8508NFOtherBCBS
TX75-1976930-005OtherTRICARE
TX75-2616977-001OtherTRICARE
TX75-0818167-015OtherTRICARE
TX8506NFOtherBCBS
TX315303305Medicaid
TX75-0818167-048OtherTRICARE
TX8507NFOtherBCBS
TX315303303Medicaid
TX75-0818167-022OtherTRICARE
TX75-2616977-002OtherTRICARE
TX8505NFOtherBCBS
TX315303302Medicaid
TX273871YMAFMedicare PIN
TX8505NFOtherBCBS
TX75-0818167-044OtherTRICARE
TXP01317453Medicare Oscar/Certification
TXP01318057Medicare Oscar/Certification
TXP01317427Medicare Oscar/Certification