Provider Demographics
NPI:1497890560
Name:BROOKS, VICKI (CNM)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3513
Mailing Address - Country:US
Mailing Address - Phone:334-279-9333
Mailing Address - Fax:334-279-9381
Practice Address - Street 1:495 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3513
Practice Address - Country:US
Practice Address - Phone:334-279-9333
Practice Address - Fax:334-279-9381
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-032096367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL46576OtherBCBS OF AL