Provider Demographics
NPI:1164822490
Name:BROOKS, MELINDA (NP-C)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 S VALLEY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3165
Mailing Address - Country:US
Mailing Address - Phone:575-526-7777
Mailing Address - Fax:575-526-7748
Practice Address - Street 1:2970 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1152
Practice Address - Country:US
Practice Address - Phone:575-525-3531
Practice Address - Fax:575-525-3534
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily