Provider Demographics
NPI:1821211541
Name:BROOKS, CASEY D (APN)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:D
Last Name:BROOKS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W END AVE
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-1725
Mailing Address - Country:US
Mailing Address - Phone:615-446-2839
Mailing Address - Fax:615-441-1900
Practice Address - Street 1:301 W END AVE
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1725
Practice Address - Country:US
Practice Address - Phone:615-446-2839
Practice Address - Fax:615-441-1900
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN150246163W00000X
TN17770363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN150246OtherRN
TN17770OtherAPN