Provider Demographics
NPI:1689651986
Name:BROOKS, RHODABECA B (PA)
Entity Type:Individual
Prefix:MRS
First Name:RHODABECA
Middle Name:B
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 UNIVERSITY DR E
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-2661
Practice Address - Country:US
Practice Address - Phone:979-691-3300
Practice Address - Fax:979-691-3527
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07031363AM0700X, 363A00000X
WAPA10003761363AM0700X
ORPA00774363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187842301Medicaid
TX1275726853OtherCOLLEGE STATION/ABC
TX1821185299OtherAGENCY NPI
WA3929BROtherREGENCE RIDER NUMBER
WA0220759OtherLABOR AND INDUSTRIES
WA8480493Medicaid
WA8480493Medicaid
WA3929BROtherREGENCE RIDER NUMBER
WA8480493Medicaid