Provider Demographics
NPI:1558176495
Name:BROOKS, MELISSA JEAN (RN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEAN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 THOUSAND OAKS LN
Mailing Address - Street 2:
Mailing Address - City:JOSHUA
Mailing Address - State:TX
Mailing Address - Zip Code:76058-4710
Mailing Address - Country:US
Mailing Address - Phone:765-429-7616
Mailing Address - Fax:
Practice Address - Street 1:112 THOUSAND OAKS LN
Practice Address - Street 2:
Practice Address - City:JOSHUA
Practice Address - State:TX
Practice Address - Zip Code:76058-4710
Practice Address - Country:US
Practice Address - Phone:765-429-7616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY921415163W00000X
372600000X
TX921415163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered Nurse
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty