Provider Demographics
NPI:1982431300
Name:BROOKS, MEGGIN BEA
Entity type:Individual
Prefix:
First Name:MEGGIN
Middle Name:BEA
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1839 MADISON AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-2789
Mailing Address - Country:US
Mailing Address - Phone:518-312-8058
Mailing Address - Fax:
Practice Address - Street 1:1839 MADISON AVE APT 207
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2789
Practice Address - Country:US
Practice Address - Phone:518-312-8058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant