Provider Demographics
NPI:1225775414
Name:BROOKS, JESSICA LOUISE (FNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LOUISE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 PIMPERNEL RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-6775
Mailing Address - Country:US
Mailing Address - Phone:704-595-3742
Mailing Address - Fax:704-595-3788
Practice Address - Street 1:8824 E BELLHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-6775
Practice Address - Country:US
Practice Address - Phone:704-595-3742
Practice Address - Fax:704-595-3788
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016752363LF0000X, 207Q00000X, 261QH0100X, 363LF0000X
NC00000000000000000000207QA0505X
NCBROO-6G65J363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty