Provider Demographics
NPI:1487005682
Name:BROOKS, JIMMETTE N (MD)
Entity Type:Individual
Prefix:DR
First Name:JIMMETTE
Middle Name:N
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-5476
Mailing Address - Country:US
Mailing Address - Phone:401-822-2772
Mailing Address - Fax:401-821-5260
Practice Address - Street 1:595 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-5476
Practice Address - Country:US
Practice Address - Phone:401-822-2772
Practice Address - Fax:401-821-5260
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
RIMD16412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program