Provider Demographics
NPI:1013373141
Name:BROOKS, INESSA PAVLOVNA (PAC)
Entity Type:Individual
Prefix:
First Name:INESSA
Middle Name:PAVLOVNA
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:INESSA
Other - Middle Name:PAVLOVNA
Other - Last Name:CHERNISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:980 PROFESSIONAL PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5251
Practice Address - Country:US
Practice Address - Phone:931-905-1001
Practice Address - Fax:931-905-0410
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2887363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical