Provider Demographics
NPI:1609385392
Name:SCALLION, BROOKE (FNP-C)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:SCALLION
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:TUTWILER
Mailing Address - State:MS
Mailing Address - Zip Code:38963-5184
Mailing Address - Country:US
Mailing Address - Phone:662-902-6975
Mailing Address - Fax:
Practice Address - Street 1:121 E BAKER ST
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:MS
Practice Address - Zip Code:38751-2450
Practice Address - Country:US
Practice Address - Phone:662-887-5235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902267207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine