Provider Demographics
NPI:1427549773
Name:BROOKINS, MICOLE ALESIA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MICOLE
Middle Name:ALESIA
Last Name:BROOKINS
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:MICOLE
Other - Middle Name:A
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5012 CHESEBRO RD STE 200
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2287
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16530 VENTURA BLVD STE 400
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4551
Practice Address - Country:US
Practice Address - Phone:818-835-3089
Practice Address - Fax:818-746-1833
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014962363LN0000X, 363LN0005X, 363LP0808X
IN28221362A363LN0000X
IN71007988A363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care