Provider Demographics
NPI:1174228951
Name:BROOKS, DAMARIS AMBER
Entity type:Individual
Prefix:
First Name:DAMARIS
Middle Name:AMBER
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 1:905 THUNDER RD STE 240
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-7672
Mailing Address - Country:US
Mailing Address - Phone:252-334-0555
Mailing Address - Fax:844-494-0230
Practice Address - Street 1:905 THUNDER RD STE 240
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-7672
Practice Address - Country:US
Practice Address - Phone:252-334-0555
Practice Address - Fax:844-494-0230
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000992367A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program