Provider Demographics
NPI:1831656701
Name:BROOKS, KIWANA TRECHELLE (APRN)
Entity Type:Individual
Prefix:
First Name:KIWANA
Middle Name:TRECHELLE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 GOVERNMENT BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-4310
Mailing Address - Country:US
Mailing Address - Phone:251-300-7314
Mailing Address - Fax:251-202-7851
Practice Address - Street 1:3501 GULF SHORES PKWY
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-5710
Practice Address - Country:US
Practice Address - Phone:251-300-7134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11001515363LP0808X
AL1-103823363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health