Provider Demographics
NPI:1497398721
Name:BROOKS, BROOKE ALEXA (PA-C)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALEXA
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ALEXA
Other - Last Name:GABANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1144 OAKCREST DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-9328
Mailing Address - Country:US
Mailing Address - Phone:610-751-0374
Mailing Address - Fax:
Practice Address - Street 1:3227 WALTER DR STE 1B
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-8171
Practice Address - Country:US
Practice Address - Phone:843-872-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMPA.3354PA207RG0100X
SC3354363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology