Provider Demographics
NPI:1417953548
Name:BROOKS, LAURA KNIGHT (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KNIGHT
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 W HUDSON BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-6430
Mailing Address - Country:US
Mailing Address - Phone:704-853-5294
Mailing Address - Fax:704-862-5383
Practice Address - Street 1:119 W PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BESSEMER CITY
Practice Address - State:NC
Practice Address - Zip Code:28016-2635
Practice Address - Country:US
Practice Address - Phone:704-629-3465
Practice Address - Fax:704-629-1355
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001000049363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCR115365Medicaid
P84220Medicare UPIN
NC2763338Medicare Oscar/Certification