Provider Demographics
NPI:1255914461
Name:BROOKS, KHADIJA W (NP)
Entity type:Individual
Prefix:
First Name:KHADIJA
Middle Name:W
Last Name:BROOKS
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 W WALKER ST APT 1223
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6889
Mailing Address - Country:US
Mailing Address - Phone:318-617-5650
Mailing Address - Fax:
Practice Address - Street 1:9850C EMMETT F LOWRY EXPY STE C103
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2122
Practice Address - Country:US
Practice Address - Phone:409-938-2234
Practice Address - Fax:409-938-2200
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143146363LP2300X
AL1-202068363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX843631OtherNURSING LICENSE