Provider Demographics
NPI:1942972773
Name:BROOKS, AMY LYNNE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNNE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNNE
Other - Last Name:FREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, APRN, FNP-C
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75833-0490
Mailing Address - Country:US
Mailing Address - Phone:039-512-1438
Mailing Address - Fax:
Practice Address - Street 1:200 RENAISSANCE WAY
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-1772
Practice Address - Country:US
Practice Address - Phone:936-243-6568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX855948163W00000X
TXF09211612363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse