Provider Demographics
NPI:1427674472
Name:BROOKS, AMANDA KATHERINE (DNP, FNP-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KATHERINE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:KATHERINE
Other - Last Name:POOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, FNP-C
Mailing Address - Street 1:PO BOX 17930
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72222-7930
Mailing Address - Country:US
Mailing Address - Phone:501-663-0490
Mailing Address - Fax:501-663-5948
Practice Address - Street 1:8907 KANIS RD STE 330
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6451
Practice Address - Country:US
Practice Address - Phone:501-224-8810
Practice Address - Fax:501-224-9076
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR228146363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116280700Medicaid
AR228146OtherLICENSE
AR329173758Medicaid