Provider Demographics
NPI:1699906305
Name:BROOKS, KRISTIN (PMHNP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 NE NORTON AVE. STE. 3
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4386
Mailing Address - Country:US
Mailing Address - Phone:541-350-6913
Mailing Address - Fax:866-233-7513
Practice Address - Street 1:336 NE NORTON AVE. STE. 3
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3598
Practice Address - Country:US
Practice Address - Phone:541-350-6913
Practice Address - Fax:866-233-7513
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201050080NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health