Provider Demographics
NPI:1043805575
Name:BROOKS, KELLI BROOKE (MSN, NNP-BC)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:BROOKE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MSN, NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:SILSBEE
Mailing Address - State:TX
Mailing Address - Zip Code:77656-6209
Mailing Address - Country:US
Mailing Address - Phone:409-673-0506
Mailing Address - Fax:
Practice Address - Street 1:2830 CALDER ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1809
Practice Address - Country:US
Practice Address - Phone:409-892-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10315992080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine